Healthcare Provider Details

I. General information

NPI: 1730175720
Provider Name (Legal Business Name): JOHN LLOYD BEZZANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4A330 SCHOOL OF MEDICINE
SALT LAKE CITY UT
84132-2409
US

IV. Provider business mailing address

558 S MURDOCK DR
PLEASANT GROVE UT
84062-3271
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6465
  • Fax: 801-581-6484
Mailing address:
  • Phone: 801-581-6465
  • Fax: 801-581-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number319
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: