Provider Demographics
NPI:1053491183
Name:DEBENHAM, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DEBENHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1380 EAST MEDICAL CENTER DRIVE
Practice Address - Street 2:DIXIE REGIONAL MEDICAL CENTER
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-251-1000
Practice Address - Fax:801-990-1912
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184722-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2090168OtherUNITED HEALTHCARE
UT870545614DEBOtherEDUCATORS MUTUAL
UTQM0000075886OtherALTIUS
WY118909300Medicaid
UT24592OtherDESERET MUTUAL
UT71443OtherPEHP
NV002088120Medicaid
AZ066812002Medicaid
ID806392300Medicaid
UT107005903103OtherIHC
UT52858OtherHEALTHY U
UTPRA02634OtherMOLINA
UT005532791Medicare ID - Type Unspecified
UT050091527Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ID806392300Medicaid