Provider Demographics
NPI:1487698445
Name:KING, TREVOR PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:PAUL
Last Name:KING
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 1:3430 W EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6961
Mailing Address - Country:US
Mailing Address - Phone:573-635-0233
Mailing Address - Fax:
Practice Address - Street 1:3430 W EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6961
Practice Address - Country:US
Practice Address - Phone:573-635-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005032732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200101509Medicaid
MO207176603Medicaid
P00374043OtherRAILROAD MEDICARE
MOP01135224OtherRAILROAD MEDICARE
P00374043OtherRAILROAD MEDICARE
MO200101509Medicaid
929382943Medicare PIN
MO152810049Medicare PIN