Healthcare Provider Details

I. General information

NPI: 1730133109
Provider Name (Legal Business Name): BEN R KOCHMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10359 N FEDERAL BLVD SUITE 210
WESTMINSTER CO
80260
US

IV. Provider business mailing address

10359 N FEDERAL BLVD SUITE 210
WESTMINSTER CO
80260
US

V. Phone/Fax

Practice location:
  • Phone: 303-404-0200
  • Fax: 303-404-2828
Mailing address:
  • Phone: 303-404-0200
  • Fax: 303-404-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1655
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: