Healthcare Provider Details

I. General information

NPI: 1427708718
Provider Name (Legal Business Name): TRENT BRADFORD HASLAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S FASHION BLVD STE 120
MURRAY UT
84107-8115
US

IV. Provider business mailing address

5720 S WATERBURY WAY UNIT H
SALT LAKE CITY UT
84121-1137
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-1391
  • Fax: 801-261-1394
Mailing address:
  • Phone: 801-414-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number13466294-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: