Individual
TRENT EVERARD DIRK JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8401 MEDICAL PLAZA DR, SUITE 220, CHARLOTTE, NC 28262-8797
(704) 384-1570
(704) 384-1534
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-1570
(704) 384-1534
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2014-01643
NC
208000000X
Pediatrics Physician
TL29878
SC
Other
Enumeration date
07/20/2007
Last updated
10/25/2020
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