Healthcare Provider Details

I. General information

NPI: 1881642676
Provider Name (Legal Business Name): TREVOR R WILLIAMS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 W 7000 S STE 201
WEST JORDAN UT
84084-3556
US

IV. Provider business mailing address

1561 W 7000 S SUITE 100
WEST JORDAN UT
84084-3556
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-2696
  • Fax: 801-528-6558
Mailing address:
  • Phone: 801-569-2696
  • Fax: 801-352-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number5289372-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: