Provider Demographics
NPI:1972795052
Name:BENJAMIN N STORZ MD PLLC
Entity type:Organization
Organization Name:BENJAMIN N STORZ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:STORZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-433-2873
Mailing Address - Street 1:1868 W 9800 S
Mailing Address - Street 2:100
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9060
Mailing Address - Country:US
Mailing Address - Phone:801-433-2873
Mailing Address - Fax:801-433-5734
Practice Address - Street 1:1868 W 9800 S
Practice Address - Street 2:100
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9060
Practice Address - Country:US
Practice Address - Phone:801-433-2873
Practice Address - Fax:801-433-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6020597-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6020597-1205OtherUTAH STATE LICENSE
UTBS9585362OtherDEA LICENSE