Healthcare Provider Details

I. General information

NPI: 1154543361
Provider Name (Legal Business Name): TREVOR MAGEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S 1100 E SUITE 101
SALT LAKE CITY UT
84102-1500
US

IV. Provider business mailing address

24 S 1100 E SUITE 101
SALT LAKE CITY UT
84102-1500
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-6468
  • Fax:
Mailing address:
  • Phone: 801-355-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number7654270-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number7654270-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: