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General NPI Number Information
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NPI Number | 1023172426
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Entity Type | Individual
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Provider Name | BENJAMIN K MARBLE DPM
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1619 N GREENWOOD ST # 300
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City | PUEBLO
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State | CO
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Zip | 81003-2657
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Country | US
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Telephone | 719-543-2476
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Fax | 719-543-2479
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Provider Business Mailing Address
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Address Line | 1619 N GREENWOOD ST #300
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City | PUEBLO
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State | CO
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Zip | 81003-2657
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Country | US
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Telephone | 719-543-2476
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Fax | 719-543-2479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 665
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5943612-0501
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License Number State | UT
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