Healthcare Provider Details

I. General information

NPI: 1295819621
Provider Name (Legal Business Name): TRENTEN DON THORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 PIONEER PKWY
WEST VALLEY CITY UT
84120
US

IV. Provider business mailing address

333 N 300 W
SALT LAKE CITY UT
84103-1215
US

V. Phone/Fax

Practice location:
  • Phone: 801-964-3100
  • Fax:
Mailing address:
  • Phone: 385-202-6689
  • Fax: 801-463-7341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6077654-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number6077654-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: