Provider Demographics
NPI:1053316976
Name:BENATOR, RACHEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:S
Last Name:BENATOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E 3300 S
Mailing Address - Street 2:STE B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2142
Mailing Address - Country:US
Mailing Address - Phone:801-281-2020
Mailing Address - Fax:801-487-3689
Practice Address - Street 1:1025 E 3300 S
Practice Address - Street 2:STE B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2142
Practice Address - Country:US
Practice Address - Phone:801-281-2020
Practice Address - Fax:801-487-3689
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-08-16
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
UT1774701205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E43733Medicare UPIN