Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 11899057-1205 | UT |
Y | 111NI0900X | Internist | 11899057-1205 | UT |
NPI | 1003376146 |
---|---|
Provider Name | Benjamin Robert Edward Harris |
First Address | Salt Lake City, UT 84132-0002 |
Second Address | Salt Lake City, UT 84132-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2019 |
Last Update Date | 21/08/2020 |