Provider Demographics
NPI:1326263773
Name:BENITA MEDICAL LLC
Entity Type:Organization
Organization Name:BENITA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD,
Authorized Official - Phone:801-973-7636
Mailing Address - Street 1:3465 S 4155 W
Mailing Address - Street 2:STE 2
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120
Mailing Address - Country:US
Mailing Address - Phone:801-963-7636
Mailing Address - Fax:801-963-8130
Practice Address - Street 1:3465 PIONEER PKWY
Practice Address - Street 2:STE 2
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2076
Practice Address - Country:US
Practice Address - Phone:801-963-7636
Practice Address - Fax:801-963-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT932651751205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty