Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 374963-9923 | UT |
Y | 213EG0000X | General Practice | 374963-9923 | UT |
NPI | 1003043720 |
---|---|
Provider Name | Dr. Trevor Ross Lindgren |
First Address | Orem, UT 84057-2596 |
Second Address | Orem, UT 84057-3728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2009 |
Last Update Date | 25/08/2010 |