Individual
DR. BENJAMIN HOLLIS JAMES GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5444 S. GREEN ST., MURRAY, UT 84123-5632
(801) 262-8120
(801) 262-3897
Mailing address
5444 S. GREEN ST., MURRAY, UT 84123-5632
(801) 262-8120
(801) 262-3897
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5763853-1205
UT
2085R0202X
Diagnostic Radiology Physician
A103290
CA
2085R0202X
Diagnostic Radiology Physician
M-10369
ID
2085R0202X
Diagnostic Radiology Physician
MD 60033967
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010171612
REGENCE BLUE SHIELD OF IDAHO
ID
01
—
77798
BLUE CROSS OF IDAHO
ID
05
—
808281600
—
ID
05
—
8536039
—
WA
Enumeration date
09/20/2007
Last updated
06/01/2023
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