Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 7654270-1205 | UT |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 7654270-1205 | UT |
NPI | 1154543361 |
---|---|
Provider Name | Trevor Magee |
First Address | Salt Lake City, UT 84102-1500 |
Second Address | Salt Lake City, UT 84102-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 14/07/2011 |