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General NPI Number Information
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NPI Number | 1104320902
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Entity Type | Individual
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Provider Name | BENJAMIN REED FOGG MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1776 N HIGHWAY 40, STE 101
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City | HEBER CITY
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State | UT
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Zip | 84032
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Country | US
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Telephone | 435-294-2664
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Fax | 801-274-0049
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Provider Business Mailing Address
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Address Line | 1776 N HWY 40, STE 101
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City | HEBER CITY
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State | UT
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Zip | 84032
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Country | US
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Telephone | 435-294-2664
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Fax | 801-274-0049
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11336500-1205
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License Number State | UT
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