Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 9065049-0501 | UT |
Y | 222Z00000X | Podiatrist | 9065049-0501 | UT |
N | 213ES0103X | Foot & Ankle Surgery | 9065049-0501 | UT |
NPI | 1043659055 |
---|---|
Provider Name | Benjamin Arthur Thomas |
First Address | Salt Lake City, UT 84121-6923 |
Second Address | Salt Lake City, UT 84121-6923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2013 |
Last Update Date | 18/08/2016 |