Provider Demographics
NPI:1225060676
Name:BELNAP, LEGRAND P (MD)
Entity Type:Individual
Prefix:
First Name:LEGRAND
Middle Name:P
Last Name:BELNAP
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 1:1250 E 3900 S STE 220
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1369
Mailing Address - Country:US
Mailing Address - Phone:801-262-9782
Mailing Address - Fax:801-262-8632
Practice Address - Street 1:1250 E 3900 S STE 220
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1369
Practice Address - Country:US
Practice Address - Phone:801-262-9782
Practice Address - Fax:801-262-8632
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
52930701001001OtherBLUE CROSS BLUE SHIELD
PR01029OtherMOLINA
4403014OtherCIGNA
QM0000063898OtherALTIUS
PR01029OtherMOLINA
UTP00364331Medicare PIN