Individual
MARK KENNETH BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4403 HARRISON BLVD STE 2600, OGDEN, UT 84403-3277
(801) 387-7450
(801) 387-7130
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-7450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8134401-1206
UT
363AM0700X
Medical Physician Assistant
8134401-8906
UT
363AS0400X
Surgical Physician Assistant
8134401-1206
UT
Other
Enumeration date
04/10/2012
Last updated
04/30/2026
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