Provider Demographics
NPI:1053603597
Name:PAGE, TREVOR DORIAN (DO)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:DORIAN
Last Name:PAGE
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 1:1651 E SUNCREST CIR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2553
Mailing Address - Country:US
Mailing Address - Phone:435-590-5924
Mailing Address - Fax:
Practice Address - Street 1:25 NORTH 100 EAST
Practice Address - Street 2:FAMILY HEALTHCARE
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-879-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9072036-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine