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NPI Code Detail

MEDICARE: BENJAMIN SUMNER PA

MEDICARE: BENJAMIN SUMNER PA
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
1363AM0700XMedical Physician Assistant52030CA
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1609271188
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN SUMNER PA
Provider Business Mailing Address
First Line : 1275 E FAIRFAX RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-4324
Country : US
Telephone Number : 801-536-3500
Fax Number :
Provider Business Practice Location Address
First Line : 1275 E FAIRFAX RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-4324
Country : US
Telephone Number : 801-536-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2014
Last Update Date : 03/24/2025

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Directions to “ BENJAMIN SUMNER PA” Practice Location

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