Provider Demographics
NPI:1013522564
Name:MALE FERTILITY AND PEYRONIE'S CLINIC
Entity Type:Organization
Organization Name:MALE FERTILITY AND PEYRONIE'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MD
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:TROST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-655-0015
Mailing Address - Street 1:1443 W 800 N STE 302
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2883
Mailing Address - Country:US
Mailing Address - Phone:801-655-0015
Mailing Address - Fax:801-655-0048
Practice Address - Street 1:1443 W 800 N STE 302
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2883
Practice Address - Country:US
Practice Address - Phone:801-655-0015
Practice Address - Fax:801-655-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty