Individual
BENJAMIN PANTONE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1160 E 3900 S STE 3500, SALT LAKE CITY, UT 84124-1264
(801) 476-6900
Mailing address
PO BOX 281490, ATLANTA, GA 30384-1490
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
08/06/2009
Last updated
01/02/2026
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