Individual
BENJAMIN ROBERT LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1409 REDONDO AVE, SALT LAKE CITY, UT 84105-3709
(801) 673-9482
Mailing address
1409 REDONDO AVE, SALT LAKE CITY, UT 84105-3709
(801) 673-9482
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
7471417-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
12/05/2008
Last updated
11/18/2021
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