=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427708718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRENT BRADFORD HASLAM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2022
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5801 S FASHION BLVD STE 120
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84107-8115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-261-1391
-----------------------------------------------------
Fax | 801-261-1394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5720 S WATERBURY WAY UNIT H
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84121-1137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-414-0492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 13466294-0501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------