Healthcare Provider Details

I. General information

NPI: 1881677821
Provider Name (Legal Business Name): TRENT L. HOVENGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 RUGELY CT
COLORADO SPGS CO
80906-5954
US

IV. Provider business mailing address

110 RUGELY CT
COLORADO SPGS CO
80906-5954
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-7777
  • Fax: 719-694-3565
Mailing address:
  • Phone: 719-475-7777
  • Fax: 719-694-3565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number27788
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: