Provider Demographics
NPI:1104895663
Name:BENNETT, STERLING THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:STERLING
Middle Name:THOMAS
Last Name:BENNETT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 S 900 E STE 120
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3504
Mailing Address - Country:US
Mailing Address - Phone:801-266-0055
Mailing Address - Fax:801-266-0056
Practice Address - Street 1:5330 S 900 E STE 120
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-3504
Practice Address - Country:US
Practice Address - Phone:801-266-0055
Practice Address - Fax:801-266-0056
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT186789-1205207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870326048001D4804Medicaid
UT870326048001D4804Medicaid