MEDICARE: BENITA MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	932651751205	UT

General Provider Information

NPI Number	:	1326263773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENITA MEDICAL LLC

Provider Business Mailing Address
First Line	:	3465 S 4155 W
Second Line	:	STE 2
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120
Country	:	US
Telephone Number	:	801-963-7636
Fax Number	:	801-963-8130

Provider Business Practice Location Address
First Line	:	3465 PIONEER PKWY
Second Line	:	STE 2
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2076
Country	:	US
Telephone Number	:	801-963-7636
Fax Number	:	801-963-8130

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAY MORRIS III
Credential	:	M.D,
Telephone Number	:	801-973-7636

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	08/22/2020

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Directions to “BENITA MEDICAL LLC ” Practice Location

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