Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 5400608-1205 | UT |
N | 208000000X | Pediatrician | 5400608-1205 | UT |
NPI | 1467405407 |
---|---|
Provider Name | Dr. Steven Benjamin Bleyl |
First Address | Salt Lake City, UT 84141-3021 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 07/01/2022 |