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General NPI Number Information
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NPI Number | 1073797809
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Entity Type | Individual
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Provider Name | BENJAMIN T DASTRUP MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1483 E RIDGELINE DR STE 100
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City | SOUTH OGDEN
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State | UT
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Zip | 84405-4977
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Country | US
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Telephone | 801-399-1149
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Fax | 801-399-0248
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Provider Business Mailing Address
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Address Line | 875 COUNTRY HILLS DR
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City | OGDEN
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State | UT
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Zip | 84403-2200
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Country | US
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Telephone | 801-399-1149
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Fax | 801-394-4481
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01062307
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 5484681
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License Number State | UT
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