Individual
KEVIN TRAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
4200 OCEAN ST, ATLANTIC BEACH, FL 32233-2416
(904) 564-7581
Mailing address
4200 OCEAN ST, ATLANTIC BEACH, FL 32233-2416
(904) 564-7581
(904) 564-7583
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
247200000X
Other Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710I1003X
IDMT
FL
Enumeration date
01/12/2006
Last updated
09/11/2025
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