Healthcare Provider Details

I. General information

NPI: 1427227834
Provider Name (Legal Business Name): EVERETT TREVOR, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 WHISKEYTOWN CT
REDDING CA
96001-0227
US

IV. Provider business mailing address

1145 WHISKEYTOWN CT
REDDING CA
96001-0228
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-4180
  • Fax: 530-242-6421
Mailing address:
  • Phone: 530-246-4180
  • Fax: 530-242-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number00G304360
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number00G304360
License Number StateCA

VIII. Authorized Official

Name: DR. EVERETT DEAN TREVOR
Title or Position: PRESIDENT
Credential: MD
Phone: 530-246-4180