Provider Demographics
NPI:1255435244
Name:BENNION, DAVID F (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:BENNION
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 1:1055 N 500 W
Mailing Address - Street 2:ATTN. CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-429-8000
Mailing Address - Fax:801-429-8150
Practice Address - Street 1:555 WEST SR 164 NORTH
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84651
Practice Address - Country:US
Practice Address - Phone:801-465-4813
Practice Address - Fax:801-812-5433
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1644481205207R00000X
UT164448-1205207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT04-00356OtherUTAH HEALTHCARE
UT107006632101OtherIHC
UTQM0000000037OtherALTIUS
UT36385OtherDMBA
UT110089707OtherPALMETTO
UT870281028BE4OtherEMIA
UT5841OtherPEHP
UT870281028000Medicaid
UT870281028000Medicaid
UT005502566Medicare PIN
UT870281028000Medicaid