Healthcare Provider Details

I. General information

NPI: 1902483118
Provider Name (Legal Business Name): TREVOR ROBERT MORDHORST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 CENTENNIAL HILLS BLVD STE A
CASPER WY
82609-3265
US

IV. Provider business mailing address

4140 CENTENNIAL HILLS BLVD STE A
CASPER WY
82609-3265
US

V. Phone/Fax

Practice location:
  • Phone: 307-265-7205
  • Fax: 307-235-6262
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD61572663
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number19724A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number19724A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: