Provider Demographics
NPI:1730175720
Name:BEZZANT, JOHN LLOYD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LLOYD
Last Name:BEZZANT
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 1:558 S MURDOCK DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3271
Mailing Address - Country:US
Mailing Address - Phone:801-581-6465
Mailing Address - Fax:801-581-6484
Practice Address - Street 1:4A330 SCHOOL OF MEDICINE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2409
Practice Address - Country:US
Practice Address - Phone:801-581-6465
Practice Address - Fax:801-581-6484
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT319174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107006257102OtherIHC
UT107006257102OtherIHC
UT000001284Medicare ID - Type Unspecified