Individual
BENJAMIN GRANT LAURITZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 S 1000 E STE 200, PAYSON, UT 84651-5592
(801) 465-2800
(801) 465-4770
Mailing address
15 S 1000 E STE 200, PAYSON, UT 84651-5592
(801) 465-2800
(801) 465-4770
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
125055456
IL
208000000X
Pediatrics Physician
80037461205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870549057
—
UT
Enumeration date
08/06/2008
Last updated
07/18/2022
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