Healthcare Provider Details

I. General information

NPI: 1396741716
Provider Name (Legal Business Name): ROBERT CLETIS TRENT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

1158 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-6444
  • Fax: 502-863-6334
Mailing address:
  • Phone: 502-863-6444
  • Fax: 502-863-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25340
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: