Provider Demographics
NPI:1538157920
Name:TRENT, DAVID A (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:TRENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2406
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-2406
Mailing Address - Country:US
Mailing Address - Phone:479-441-2600
Mailing Address - Fax:479-441-2694
Practice Address - Street 1:1500 DODSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5182
Practice Address - Country:US
Practice Address - Phone:479-441-2600
Practice Address - Fax:479-441-2694
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN7791207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139724003Medicaid
OK100106740AMedicaid
OKOK404475Medicare PIN
AR139724003Medicaid
AR5AB69Medicare PIN