Provider Demographics
NPI:1841575032
Name:OVERALL, TRENTON LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:LEE
Last Name:OVERALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:208-989-1237
Mailing Address - Fax:
Practice Address - Street 1:295 S 1470 E STE 301
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1762
Practice Address - Country:US
Practice Address - Phone:435-775-2015
Practice Address - Fax:435-775-2016
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0060042084N0400X
UT9417167-12042084N0400X
UT941716712042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty