Healthcare Provider Details

I. General information

NPI: 1972795052
Provider Name (Legal Business Name): BENJAMIN N STORZ MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 W 9800 S 100
SOUTH JORDAN UT
84095-9060
US

IV. Provider business mailing address

1868 W 9800 S 100
SOUTH JORDAN UT
84095-9060
US

V. Phone/Fax

Practice location:
  • Phone: 801-433-2873
  • Fax: 801-433-5734
Mailing address:
  • Phone: 801-433-2873
  • Fax: 801-433-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6020597-1205
License Number StateUT

VIII. Authorized Official

Name: DR. BENJAMIN N STORZ
Title or Position: OWNER / MD
Credential: MD
Phone: 801-433-2873