Healthcare Provider Details

I. General information

NPI: 1265403463
Provider Name (Legal Business Name): WILLIAM BENJAMIN WARNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12391 S 4000 W
RIVERTON UT
84096-7012
US

IV. Provider business mailing address

7181 S CAMPUS VIEW DR
WEST JORDAN UT
84084-4312
US

V. Phone/Fax

Practice location:
  • Phone: 801-302-1700
  • Fax:
Mailing address:
  • Phone: 801-965-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200101151
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number10718410-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: