Healthcare Provider Details

I. General information

NPI: 1992740260
Provider Name (Legal Business Name): ORIN PAUL TRENTHAM III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 W MAIN ST
RUSSELLVILLE AR
72801-2724
US

IV. Provider business mailing address

5515 IMPALA DR
JOPLIN MO
64804-8293
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2841
  • Fax:
Mailing address:
  • Phone: 417-540-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-12463
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number106911
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: