Basic Information
| Provider Information | |||||||||
| NPI: | 1295819621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORN | ||||||||
| FirstName: | TRENTEN | ||||||||
| MiddleName: | DON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N 300 W | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841031215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3852026689 | ||||||||
| FaxNumber: | 8014637341 | ||||||||
| Practice Location | |||||||||
| Address1: | 3460 PIONEER PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST VALLEY CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019643100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 6077654-1205 | UT | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | 6077654-1205 | UT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.