Provider Demographics
NPI:1881642676
Name:WILLIAMS, TREVOR R (DPM)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 W 7000 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3556
Mailing Address - Country:US
Mailing Address - Phone:801-569-2696
Mailing Address - Fax:801-352-0400
Practice Address - Street 1:1561 W 7000 S
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3556
Practice Address - Country:US
Practice Address - Phone:801-569-2696
Practice Address - Fax:801-352-0400
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5289372-0501213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5038360001Medicare NSC
UTU95987Medicare UPIN