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: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6589 S 1300 E STE 110
MURRAY UT
84121-2435
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 801-268-2328
  • Fax: 801-252-5681
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: