Healthcare Provider Details

I. General information

NPI: 1023788536
Provider Name (Legal Business Name): BENJAMIN DONALD REETZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 MAIN AVE
DURANGO CO
81301-5919
US

IV. Provider business mailing address

PO BOX 140
RICHMOND VT
05477-0140
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-8382
  • Fax:
Mailing address:
  • Phone: 603-359-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007040
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: