Individual
TREVOR G WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 MERCADO ST, STE 202, DURANGO, CO 81301-7306
(970) 247-5362
(970) 259-6045
Mailing address
1 MERCADO ST, STE 202, DURANGO, CO 81301-7306
(970) 247-5362
(970) 259-6045
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA. 0003986
CO
363A00000X
Physician Assistant
PA2013-0074
NM
363AS0400X
Surgical Physician Assistant
Primary
PA.0003986
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57729301
—
CO
Enumeration date
11/04/2013
Last updated
02/09/2026
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