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NPI Code Detail

MEDICARE: DR. BENJAMIN WILL SCALLON M.D.

MEDICARE: DR. BENJAMIN WILL SCALLON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMD463687PA
2207R00000XInternal Medicine PhysicianR-10311IA
3207R00000XInternal Medicine Physician305535NY
4207R00000XInternal Medicine PhysicianDR.0074853CO

General Provider Information

NPI Number : 1376923250
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN WILL SCALLON M.D.
Provider Business Mailing Address
First Line : PO BOX 9049
Second Line :
City : BOULDER
State : CO
Zip : 80301-9049
Country : US
Telephone Number : 303-415-4101
Fax Number : 303-415-4769
Provider Business Practice Location Address
First Line : 1645 BROADWAY
Second Line :
City : BOULDER
State : CO
Zip : 80302-6218
Country : US
Telephone Number : 303-415-8900
Fax Number : 303-443-6476
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2015
Last Update Date : 03/10/2026

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