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NPI 1336740505

NPI 1336740505 : BENJAMIN H REECE PA : ROOSEVELT, UT

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General NPI Number Information
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    NPI Number           |    1336740505
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    Entity Type          |    Individual 
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    Provider Name        |    BENJAMIN H REECE PA
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    11/04/2020
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    Last Update Date     |    01/29/2025
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Provider Practice Location Address
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    Address Line         |    250 W 300 N 
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    City                 |    ROOSEVELT
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    State                |    UT
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    Zip                  |    84066-2351
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    Country              |    US
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    Telephone            |    435-722-6163
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    Fax                  |    435-722-9291
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Provider Business Mailing Address
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    Address Line         |    250 W 300 N 
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    City                 |    ROOSEVELT
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    State                |    UT
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    Zip                  |    84066-2351
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    Country              |    US
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    Telephone            |    435-725-7448
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    Fax                  |    435-722-9291
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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        |    363A00000X
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    Taxonomy Name        |    Physician Assistant
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    License Number       |    PA.0006639
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    License Number State |    CO
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Taxonomy #2
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    Taxonomy Code        |    390200000X
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    Taxonomy Name        |    Student in an Organized Health Care Education/Training Program
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    License Number       |    
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    License Number State |    
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Taxonomy #3
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    Taxonomy Code        |    363A00000X
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    Taxonomy Name        |    Physician Assistant
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    License Number       |    7127124-1206
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    License Number State |    UT
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