Healthcare Provider Details

I. General information

NPI: 1992288559
Provider Name (Legal Business Name): ROBERT COLE BENJAMIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 STAFFORD LN SUITE A
DELTA CO
81416
US

IV. Provider business mailing address

PO BOX 10100
DELTA CO
81416-0008
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-6008
  • Fax: 970-546-4033
Mailing address:
  • Phone: 970-874-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0005517
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: