Individual
DR. JEFFREY GREEN BENNION
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2245 N 400 E, STE 301, NORTH LOGAN, UT 84341-1892
(435) 753-7880
(435) 753-5845
Mailing address
2245 N 400 E, STE 301, NORTH LOGAN, UT 84341-1892
(435) 753-7880
(435) 753-5845
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
274201-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
274201-9915
UTAH CONTROLLED SUBSTANCE
UT
01
—
7054
IDAHO BOARD OF PHARMACY
ID
01
—
M-6924
IDAHO STATE LICENSE
ID
Enumeration date
09/23/2005
Last updated
03/07/2023
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