Provider Demographics
NPI:1932469459
Name:CHRISTENSEN, BENJAMIN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:CHRISTENSEN
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 1:13638 S MERIBEL WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6914
Mailing Address - Country:US
Mailing Address - Phone:385-985-5353
Mailing Address - Fax:801-495-7990
Practice Address - Street 1:13638 S MERIBEL WAY
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6914
Practice Address - Country:US
Practice Address - Phone:385-985-5353
Practice Address - Fax:801-495-7990
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8699717-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine