DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: BENJAMIN PANTONE WALLACE PA

MEDICARE: BENJAMIN PANTONE WALLACE 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
1363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1992936066
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN PANTONE WALLACE PA
Provider Business Mailing Address
First Line : PO BOX 281490
Second Line :
City : ATLANTA
State : GA
Zip : 30384-1490
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1160 E 3900 S STE 3500
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84124-1264
Country : US
Telephone Number : 801-476-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2009
Last Update Date : 01/02/2026

Similar Medicare Providers

1578566154 — THOMAS L CURETON PA-C
Practice Location Address:
1160 E 3900 S STE 4050
SALT LAKE CITY, UT
84124-1264
Practice Phone: 801-262-8486
Practice Fax: 801-284-8699
1992707657 — DR. JOEL T DALL MD
Practice Location Address:
1160 E 3900 S STE 4050
SALT LAKE CITY, UT
84124-1264
Practice Phone: 801-262-8486
Practice Fax: 801-284-8699
1679565170 — DR. BRUCE Y NEWTON MD
Practice Location Address:
1160 E 3900 S STE 4050
SALT LAKE CITY, UT
84124-1264
Practice Phone: 801-262-8486
Practice Fax: 801-284-8699
1497954416 — DR. RAFE C CONNORS MD
Practice Location Address:
1160 E 3900 S STE 3500
SALT LAKE CITY, UT
84124-1264
Practice Phone: 801-476-6900
Practice Fax:
1124299714 — DR. BENJAMIN DAVID CURTIS M.D.
Practice Location Address:
1160 E 3900 S STE 4050
SALT LAKE CITY, UT
84124-1264
Practice Phone: 801-262-8486
Practice Fax: 801-284-8699
1881030443 — MICHAEL HAL BOURNE JR. MD
Practice Location Address:
1160 E 3900 S STE 4050
SALT LAKE CITY, UT
84124-1264
Practice Phone: 801-266-3418
Practice Fax:

Directions to “ BENJAMIN PANTONE WALLACE PA” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.