Healthcare Provider Details

I. General information

NPI: 1679771414
Provider Name (Legal Business Name): BENJAMIN DAVID STEPHENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E BEAVER AVE
FORT MORGAN CO
80701-3103
US

IV. Provider business mailing address

1719 HIGHWAY 183 PO BOX 547
PHILLIPSBURG KS
67661-2549
US

V. Phone/Fax

Practice location:
  • Phone: 970-458-5216
  • Fax: 720-247-9072
Mailing address:
  • Phone: 785-543-5211
  • Fax: 785-543-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0062767
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: