Basic Information
| Provider Information | |||||||||
| NPI: | 1730317736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORN | ||||||||
| FirstName: | TREVOR | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 BAHIA VISTA ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342392640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419512663 | ||||||||
| FaxNumber: | 9415523312 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 BAHIA VISTA ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419512663 | ||||||||
| FaxNumber: | 9415523312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 14593 | RI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 52941 | MN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | ME124160 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.