Provider Demographics
NPI:1871760439
Name:WIDMER, BENJAMIN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JAMES
Last Name:WIDMER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:STE 120
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:801-647-1339
Mailing Address - Fax:
Practice Address - Street 1:5848 FASHION BLVD
Practice Address - Street 2:STE 120
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6121
Practice Address - Country:US
Practice Address - Phone:801-314-4100
Practice Address - Fax:801-314-4919
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT6020462-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery