Healthcare Provider Details

I. General information

NPI: 1043659055
Provider Name (Legal Business Name): BENJAMIN ARTHUR THOMAS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N GATEWAY DR STE 801
PROVIDENCE UT
84332-9004
US

IV. Provider business mailing address

435 N GATEWAY DR STE 801
PROVIDENCE UT
84332-9004
US

V. Phone/Fax

Practice location:
  • Phone: 435-787-1023
  • Fax: 435-787-1882
Mailing address:
  • Phone: 435-787-1023
  • Fax: 435-787-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number9065049-0501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number9065049-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: