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General NPI Number Information
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NPI Number | 1700193034
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Entity Type | Organization
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Legal Business Name | BENDER MEDICAL GROUP
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 4674 SNOW MESA DR STE 140
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City | FORT COLLINS
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State | CO
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Zip | 80528-8614
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Country | US
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Telephone | 970-225-5000
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Fax | 970-482-9646
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Provider Business Mailing Address
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Address Line | 4674 SNOW MESA DR STE 140
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City | FORT COLLINS
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State | CO
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Zip | 80528-8614
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Country | US
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Telephone | 970-482-0213
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Fax | 970-482-9646
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Authorized Official
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Title or Position | PRACTICE ADMIN
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Name | JULIE M DESAIRE
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Credential |
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Telephone | 970-225-5107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32679
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License Number State | CO
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