MEDICARE: JOHN W TREHARNE 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	207Q00000X	Family Medicine Physician	ME33104	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080095082	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53556	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568415503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN W TREHARNE MD

Provider Business Mailing Address
First Line	:	1340 TUSKAWILLA RD
Second Line	:	SUITE 101-105
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5030
Country	:	US
Telephone Number	:	407-699-1160
Fax Number	:	407-699-7861

Provider Business Practice Location Address
First Line	:	1340 TUSKAWILLA RD
Second Line	:	SUITE 101-105
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5030
Country	:	US
Telephone Number	:	407-699-1160
Fax Number	:	407-699-7861

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/04/2010

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