Healthcare Provider Details

I. General information

NPI: 1720919293
Provider Name (Legal Business Name): BENJAMIN GIBSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 W TROPICAL PKWY
LAS VEGAS NV
89149-4528
US

IV. Provider business mailing address

2156 N HILL FIELD RD STE 3
LAYTON UT
84041-4780
US

V. Phone/Fax

Practice location:
  • Phone: 702-656-8484
  • Fax:
Mailing address:
  • Phone: 801-203-4055
  • Fax: 801-252-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14237284-4602
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: