Healthcare Provider Details

I. General information

NPI: 1700143930
Provider Name (Legal Business Name): TREVOR REED SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E 1400 N STE 150
LOGAN UT
84341-2549
US

IV. Provider business mailing address

3571 N MORGAN VALLEY DR
MORGAN UT
84050-9606
US

V. Phone/Fax

Practice location:
  • Phone: 435-932-2038
  • Fax: 435-359-2856
Mailing address:
  • Phone: 801-710-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8841776-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number8841776-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: