Provider Demographics
NPI:1740210780
Name:BENTHUYSEN, JAMES LESTER
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LESTER
Last Name:BENTHUYSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 EAST FORT UNION BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:801-993-9500
Mailing Address - Fax:
Practice Address - Street 1:1321 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1665
Practice Address - Country:US
Practice Address - Phone:425-258-3678
Practice Address - Fax:425-258-3048
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026673207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3744BEOtherBS REGENCE
WA8202657Medicaid
189627OtherL&I
189627OtherL&I
A50753Medicare UPIN