Provider Demographics
NPI:1093956211
Name:PALMER, BENJAMIN WILLIAM
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:PALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:WILLIAM
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RT
Mailing Address - Street 1:524 S 1000 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2617
Mailing Address - Country:US
Mailing Address - Phone:801-602-6117
Mailing Address - Fax:
Practice Address - Street 1:524 S 1000 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2617
Practice Address - Country:US
Practice Address - Phone:801-602-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5297981-5401243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant