Basic Information
| Provider Information | |||||||||
| NPI: | 1821575259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOD | ||||||||
| FirstName: | TRENT | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 841656 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752841656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035315000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 E DAWSON ST | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757012036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035938441 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2018 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 8LD210 | 01 | TX | BCBS | OTHER | 1F9363 | 01 | TX | MEDICARE | OTHER | 391696704 | 05 | TX | MEDICAID | 815619 | 01 | TX | MEDICARE | OTHER | 8LD200 | 01 | TX | BCBS | OTHER | P02270210 | 01 | TX | MEDICARE RAIL ROAD | OTHER | P02409948 | 01 | TX | MEDICARE RAIL ROAD | OTHER | 391696702 | 05 | TX | MEDICAID | 815831 | 01 | TX | MEDICARE | OTHER |