Healthcare Provider Details

I. General information

NPI: 1992007439
Provider Name (Legal Business Name): TREVER LYNN WILKINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 S ALMA SCHOOL RD STE 15
CHANDLER AZ
85224-7633
US

IV. Provider business mailing address

3269 STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

V. Phone/Fax

Practice location:
  • Phone: 480-660-8817
  • Fax: 949-577-4124
Mailing address:
  • Phone: 928-692-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR1798
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number005759
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA-1777-13
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number005759
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: