Provider Demographics
NPI:1497707343
Name:BENOWITZ, BARRY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ALAN
Last Name:BENOWITZ
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 1:324 10TH AVENUE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103
Mailing Address - Country:US
Mailing Address - Phone:801-408-2600
Mailing Address - Fax:801-408-5141
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-2600
Practice Address - Fax:801-408-5141
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT159201-1205207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000005327OtherPTAN
UTC63899Medicare UPIN
UT000005327Medicare ID - Type Unspecified