Provider Demographics
NPI:1063943116
Name:COLTON, ILSLEY BEN (MD)
Entity type:Individual
Prefix:MR
First Name:ILSLEY
Middle Name:BEN
Last Name:COLTON
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 1:1409 E BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2651
Mailing Address - Country:US
Mailing Address - Phone:802-922-0872
Mailing Address - Fax:
Practice Address - Street 1:1409 E BRYAN AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2651
Practice Address - Country:US
Practice Address - Phone:802-922-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12229251-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine