Healthcare Provider Details

I. General information

NPI: 1376510800
Provider Name (Legal Business Name): SHERMAN BENNION JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 W 4700 S #5A
TAYLORSVILLE UT
84129-1847
US

IV. Provider business mailing address

2520 W 4700 S #5A
TAYLORSVILLE UT
84129-1847
US

V. Phone/Fax

Practice location:
  • Phone: 801-964-2008
  • Fax: 801-964-2435
Mailing address:
  • Phone: 801-964-2008
  • Fax: 801-964-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1646671205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: