Healthcare Provider Details

I. General information

NPI: 1235220773
Provider Name (Legal Business Name): BENJAMIN BOE SCHNURR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 E ARAPAHOE RD
GREENWOOD VILLAGE CO
80112-3703
US

IV. Provider business mailing address

9620 E ARAPAHOE RD
GREENWOOD VILLAGE CO
80112-3703
US

V. Phone/Fax

Practice location:
  • Phone: 303-835-9915
  • Fax: 303-320-5399
Mailing address:
  • Phone: 303-835-9915
  • Fax: 303-320-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101016019
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2007-00332
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48011
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: