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General NPI Number Information
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NPI Number | 1417119314
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Entity Type | Individual
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Provider Name | EDWARD THEODORE TREVINO II M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6010 W AMARILLO BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1990
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Country | US
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Telephone | 806-355-9703
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Fax |
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Provider Business Mailing Address
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Address Line | 6010 W AMARILLO BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1990
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Country | US
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Telephone | 806-355-9703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 260083
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License Number State | NY
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