Provider Demographics
NPI:1922653039
Name:ROBERTS, BENJAMIN DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DANIEL
Last Name:ROBERTS
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 1:437 W 300 S
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-9241
Mailing Address - Country:US
Mailing Address - Phone:801-427-2110
Mailing Address - Fax:
Practice Address - Street 1:437 W 300 S
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-9241
Practice Address - Country:US
Practice Address - Phone:801-427-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant