Healthcare Provider Details

I. General information

NPI: 1174546337
Provider Name (Legal Business Name): TRENT C. HOLMBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12481 S FORT ST STE 275
DRAPER UT
84020-2106
US

IV. Provider business mailing address

12481 S FORT ST STE 275
DRAPER UT
84020-2106
US

V. Phone/Fax

Practice location:
  • Phone: 801-432-2077
  • Fax: 801-432-2079
Mailing address:
  • Phone: 801-432-2077
  • Fax: 801-432-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number376105-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number3761051205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: