Healthcare Provider Details

I. General information

NPI: 1588655856
Provider Name (Legal Business Name): STANFORD J BENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-1000
  • Fax: 435-688-5514
Mailing address:
  • Phone: 435-251-1000
  • Fax: 435-688-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number260619-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: