Provider Demographics
NPI:1205008844
Name:MATHIS, TREVOR JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:JAMES
Last Name:MATHIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:150 W 100 N STE 102-S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2036
Mailing Address - Country:US
Mailing Address - Phone:435-781-2161
Mailing Address - Fax:435-781-2162
Practice Address - Street 1:150 W 100 N STE 102-S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2036
Practice Address - Country:US
Practice Address - Phone:435-781-2161
Practice Address - Fax:435-781-2162
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2013-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT8568487-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery