MEDICARE: TREVOR REED SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	8841776-1205	UT
2	207R00000X	Internal Medicine Physician	8841776-1205	UT

General Provider Information

NPI Number	:	1700143930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR REED SMITH MD

Provider Business Mailing Address
First Line	:	3571 N MORGAN VALLEY DR
Second Line	:
City	:	MORGAN
State	:	UT
Zip	:	84050-9606
Country	:	US
Telephone Number	:	801-710-9849
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 E 1400 N STE 150
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341-2549
Country	:	US
Telephone Number	:	435-932-2038
Fax Number	:	435-359-2856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	11/19/2021

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Directions to “ TREVOR REED SMITH MD” Practice Location

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