Provider Demographics
NPI:1982788543
Name:TRENT, LEE ROYAL III (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ROYAL
Last Name:TRENT
Suffix:III
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 1:801 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3267
Mailing Address - Country:US
Mailing Address - Phone:252-830-0468
Mailing Address - Fax:252-830-0594
Practice Address - Street 1:801 EVANS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3267
Practice Address - Country:US
Practice Address - Phone:252-830-0468
Practice Address - Fax:252-830-0594
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8983714Medicaid
NC202082Medicare ID - Type Unspecified
NC8983714Medicaid