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General NPI Number Information
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NPI Number | 1932407277
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Entity Type | Organization
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Legal Business Name | STEPHEN H BENNETT MD PC
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 1045 E 3900 S STE 201
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1192
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Country | US
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Telephone | 801-266-4212
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 E 3900 S STE 201
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1192
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Country | US
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Telephone | 801-266-4212
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN BENNETT
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Credential | MD
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Telephone | 801-266-4212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 161245-1205
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License Number State | UT
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