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General NPI Number Information
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NPI Number | 1558542688
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Entity Type | Organization
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Legal Business Name | JOHN L. BEZZANT, M.D. P.C.
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 84 S MAIN ST
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2630
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Country | US
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Telephone | 801-785-7414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 830
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-0830
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Country | US
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Telephone | 801-785-7414
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/BUSINESS OWNER
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Name | JOHN LLOYD BEZZANT
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Credential | M.D.
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Telephone | 801-785-7414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 162911-1205
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License Number State | UT
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