Basic Information
| Provider Information | |||||||||
| NPI: | 1255435244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNION | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 N 500 W | ||||||||
| Address2: | ATTN. CREDENTIALING | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014298000 | ||||||||
| FaxNumber: | 8014298150 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 WEST SR 164 NORTH | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014654813 | ||||||||
| FaxNumber: | 8018125433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 1644481205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 164448-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04-00356 | 01 | UT | UTAH HEALTHCARE | OTHER | 107006632101 | 01 | UT | IHC | OTHER | QM0000000037 | 01 | UT | ALTIUS | OTHER | 36385 | 01 | UT | DMBA | OTHER | 110089707 | 01 | UT | PALMETTO | OTHER | 870281028BE4 | 01 | UT | EMIA | OTHER | 5841 | 01 | UT | PEHP | OTHER |