MEDICARE: TRENTON KINNEAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	43144	OK
2	2086S0129X	Vascular Surgery Physician	43144	OK

General Provider Information

NPI Number	:	1538540935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENTON KINNEAR MD

Provider Business Mailing Address
First Line	:	1924 ALCOA HWY # U-11
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1511
Country	:	US
Telephone Number	:	865-305-9230
Fax Number	:	865-305-8894

Provider Business Practice Location Address
First Line	:	3433 NW 56TH ST STE 760
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4461
Country	:	US
Telephone Number	:	405-951-4345
Fax Number	:	405-951-4392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	12/30/2024

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