Provider Demographics
NPI:1013986157
Name:TROTTER, LEE DUPONT (DO)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:DUPONT
Last Name:TROTTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W 800 N STE 330
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3660
Mailing Address - Country:US
Mailing Address - Phone:801-714-6404
Mailing Address - Fax:
Practice Address - Street 1:750 W 800 N STE 330
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3660
Practice Address - Country:US
Practice Address - Phone:801-714-6404
Practice Address - Fax:801-714-6401
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4681208600000X
UT10975405-12042086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery