Individual
BENJAMIN G LAROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4403 HARRISON BLVD STE 700A, OGDEN, UT 84403-3295
(801) 387-5300
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-5300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50479251204
UT
Other
Enumeration date
06/23/2009
Last updated
02/01/2010
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