Individual
BENJAMIN FREDRICK JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5121 S COTTONWOOD ST, SALT LAKE CITY, UT 84107-5701
(801) 507-7000
Mailing address
2807 E 4215 S, SALT LAKE CITY, UT 84124-2900
(385) 315-0214
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
7771155-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10000009766001
REGENCE BLUE CROSS BLUE SHIELD
UT
05
—
1689991358
—
UT
01
—
U000078668
MEDICARE PTAN
UT
Enumeration date
04/21/2010
Last updated
12/19/2013
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