Healthcare Provider Details

I. General information

NPI: 1992618045
Provider Name (Legal Business Name): BENJAMIN HERBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 HOPNER CT
COLORADO SPRINGS CO
80919-7950
US

IV. Provider business mailing address

5140 HOPNER CT
COLORADO SPRINGS CO
80919-7950
US

V. Phone/Fax

Practice location:
  • Phone: 719-659-2408
  • Fax:
Mailing address:
  • Phone: 719-659-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: