Healthcare Provider Details

I. General information

NPI: 1215865589
Provider Name (Legal Business Name): BENJAMIN STCLAIR DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 N 500 W STE 200
PROVO UT
84601-1472
US

IV. Provider business mailing address

745 N 500 W STE 200
PROVO UT
84601-1472
US

V. Phone/Fax

Practice location:
  • Phone: 801-375-9292
  • Fax: 801-375-9290
Mailing address:
  • Phone: 801-375-9292
  • Fax: 801-375-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN DAVID ST CLAIR
Title or Position: DOCTOR
Credential: DO
Phone: 801-375-9292