Individual
TRENT RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5444 GREEN ST, MURRAY, UT 84123-5632
(801) 262-8120
(801) 262-3897
Mailing address
5444 GREEN ST, MURRAY, UT 84123-5632
(801) 262-8120
(801) 262-3897
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/05/2011
Last updated
08/05/2011
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