Provider Demographics
NPI:1023680519
Name:GERUN, BENJAMIN C (CRNA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:C
Last Name:GERUN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:GERUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:715 CHERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2935
Mailing Address - Country:US
Mailing Address - Phone:801-400-8626
Mailing Address - Fax:
Practice Address - Street 1:3000 N TRIUMPH BLVD
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4999
Practice Address - Country:US
Practice Address - Phone:385-345-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0004101-C-CRNA367500000X
UT8281608-4406367500000X
MERNA243051367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty