Healthcare Provider Details

I. General information

NPI: 1932407277
Provider Name (Legal Business Name): STEPHEN H BENNETT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 E 3900 S STE 201
SALT LAKE CITY UT
84124-1192
US

IV. Provider business mailing address

1045 E 3900 S STE 201
SALT LAKE CITY UT
84124-1192
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-4212
  • Fax:
Mailing address:
  • Phone: 801-266-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number161245-1205
License Number StateUT

VIII. Authorized Official

Name: DR. STEPHEN BENNETT
Title or Position: OWNER
Credential: MD
Phone: 801-266-4212