Wall, Trevor G

Wall, Trevor G is an individual health care provider with primary practice located at 1 Mercado St Ste 202, Durango CO 81301-7306. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Wall, Trevor G can be contacted via phone (970) 247-5362.

Contact Information

Primary practice address
1 Mercado St Ste 202 Durango CO 81301-7306
Phone: (970) 247-5362
Fax: (970) 259-6045
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA2013-0074 New Mexico
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA.0003986 Colorado

Profile Details

NPI number 1366871972
LBN Legal business name Wall, Trevor G
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 4th, 2013
Last updated Feb 9th, 2026 - about 8 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366871972 NPPES
Colorado MEDICAID 57729301

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