Basic Information
Provider Information
NPI: 1114156726
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITING
FirstName: TREVOR
MiddleName: KEITH
NamePrefix: DR.
NameSuffix:  
Credential: D.P.M.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3649
Address2:  
City: SPOKANE
State: WA
PostalCode: 992203649
CountryCode: US
TelephoneNumber: 5098382531
FaxNumber:  
Practice Location
Address1: 400 E 5TH AVE
Address2:  
City: SPOKANE
State: WA
PostalCode: 992021334
CountryCode: US
TelephoneNumber: 5098382531
FaxNumber: 5097556580
Other Information
ProviderEnumerationDate: 07/06/2009
LastUpdateDate: 08/06/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/06/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103XOP60294170WAN Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
213ES0103X5901002330MIN Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
213ES0103XPOD.0000886COY Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery

No ID Information.


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