Healthcare Provider Details

I. General information

NPI: 1104895663
Provider Name (Legal Business Name): STERLING THOMAS BENNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 S 900 E STE 120
MURRAY UT
84117-3504
US

IV. Provider business mailing address

5330 S 900 E STE 120
MURRAY UT
84117-3504
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-0055
  • Fax: 801-266-0056
Mailing address:
  • Phone: 801-266-0055
  • Fax: 801-266-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number186789-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number186789-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: