=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457336737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD N BEHEN DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2005
-----------------------------------------------------
Last Update Date | 04/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2217 N 7TH ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-7423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-245-1579
-----------------------------------------------------
Fax | 970-241-5158
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2217 N 7TH ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-7423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-245-1579
-----------------------------------------------------
Fax | 970-245-1582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 295
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------