Individual
CAMERON LEWIS BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS, PA-C
Contact information
Practice address
409 W 400 S, SALT LAKE CITY, UT 84101-1135
(801) 364-0058
Mailing address
409 W 400 S, SALT LAKE CITY, UT 84101-1135
(801) 364-0058
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
12456910-1206
UT
363A00000X
Physician Assistant
Primary
12456910-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/15/2020
Last updated
03/04/2024
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