Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 12758 | WV |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 12758 | WV |
NPI | 1124002043 |
---|---|
Provider Name | Dr. Richard Stockton Trenbath |
First Address | Lewisburg, WV 24901-4049 |
Second Address | Summersville, WV 26651-1901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 25/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002684077 | HIGHMARK BCBS (01) | WV |
0053183000 | (05) | WV |
3810022256 | (05) | WV |
F25428 | (02) | WV |