Provider Demographics
NPI:1710388160
Name:HAYMOND, BENJAMIN SMITH (PA-C)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SMITH
Last Name:HAYMOND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W 7200 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1043
Mailing Address - Country:US
Mailing Address - Phone:801-858-3461
Mailing Address - Fax:801-955-2389
Practice Address - Street 1:4745 S 3200 W
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2822
Practice Address - Country:US
Practice Address - Phone:801-964-6214
Practice Address - Fax:877-497-4661
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9133379-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant