Provider Demographics
NPI:1184043325
Name:HAMMOND, BENJAMIN HARLAN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HARLAN
Last Name:HAMMOND
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:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:395 W COUGAR BLVD STE 702
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3333
Practice Address - Country:US
Practice Address - Phone:801-357-1700
Practice Address - Fax:801-357-1709
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.132058208000000X, 2080P0202X
UT12868145-12052080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics