Healthcare Provider Details

I. General information

NPI: 1992960074
Provider Name (Legal Business Name): DAVID BENJAMIN HARRIS BC-HIS, ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 E 170 S STE 201
ST GEORGE UT
84790-3012
US

IV. Provider business mailing address

1363 E 170 S STE 201
ST GEORGE UT
84790-3012
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-4938
  • Fax: 435-674-0205
Mailing address:
  • Phone: 435-674-4938
  • Fax: 435-674-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3085847-4601
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: