Healthcare Provider Details

I. General information

NPI: 1588849483
Provider Name (Legal Business Name): ROY H TRAWICK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 FASHION BLVD STE 110
MURRAY UT
84107-6121
US

IV. Provider business mailing address

5848 FASHION BLVD STE 110
MURRAY UT
84107-6121
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4345
  • Fax: 801-314-4015
Mailing address:
  • Phone: 801-314-4345
  • Fax: 801-314-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number3595641205
License Number StateUT

VIII. Authorized Official

Name: GENE OAKES
Title or Position: BUSINESS ADMINISTRATOR
Credential: CPA
Phone: 801-314-4345