Healthcare Provider Details

I. General information

NPI: 1265642227
Provider Name (Legal Business Name): TOMMY ARIC TRENT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61603-3133
US

IV. Provider business mailing address

3130 N BIGELOW ST
PEORIA IL
61604-1628
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-6710
  • Fax:
Mailing address:
  • Phone: 309-682-0164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: