MEDICARE: LEGRAND P BELNAP M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	52930701001001	OTHER	BLUE CROSS BLUE SHIELD
2	PR01029	OTHER	MOLINA
3	4403014	OTHER	CIGNA
4	QM0000063898	OTHER	ALTIUS

General Provider Information

NPI Number	:	1225060676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEGRAND P BELNAP M.D.

Provider Business Mailing Address
First Line	:	1250 E 3900 S STE 220
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1369
Country	:	US
Telephone Number	:	801-262-9782
Fax Number	:	801-262-8632

Provider Business Practice Location Address
First Line	:	1250 E 3900 S STE 220
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1369
Country	:	US
Telephone Number	:	801-262-9782
Fax Number	:	801-262-8632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	01/09/2008

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Directions to “ LEGRAND P BELNAP M.D.” Practice Location

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