Provider Demographics
NPI:1013074558
Name:TREDWAY, TRENT LANE (MD)
Entity Type:Individual
Prefix:MR
First Name:TRENT
Middle Name:LANE
Last Name:TREDWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 OLIVE WAY APT 2502
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3751
Mailing Address - Country:US
Mailing Address - Phone:206-623-1334
Mailing Address - Fax:206-623-1677
Practice Address - Street 1:737 OLIVE WAY APT 2502
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3751
Practice Address - Country:US
Practice Address - Phone:206-623-1334
Practice Address - Fax:206-623-1677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043699207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0232078OtherL&I
WA1013074558Medicaid
320940OtherINTERNAL ID-MOTOR VEHICLE ID
WA1013074558Medicaid
320940OtherINTERNAL ID-MOTOR VEHICLE ID