Provider Demographics
NPI:1427708718
Name:HASLAM, TRENT BRADFORD
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:BRADFORD
Last Name:HASLAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 S WATERBURY WAY UNIT H
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1137
Mailing Address - Country:US
Mailing Address - Phone:801-414-0492
Mailing Address - Fax:
Practice Address - Street 1:5801 S FASHION BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8115
Practice Address - Country:US
Practice Address - Phone:801-261-1391
Practice Address - Fax:801-261-1394
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13466294-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery