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General NPI Number Information
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NPI Number | 1811864630
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Entity Type | Individual
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Provider Name | BENJAMIN JAMES WAKEFIELD PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 2240 BLAKE ST STE 101
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City | DENVER
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State | CO
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Zip | 80205-2059
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Country | US
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Telephone | 720-664-7183
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 WEWATTA WAY APT 424
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City | DENVER
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State | CO
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Zip | 80216-3767
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0009419
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 0009419
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License Number State | CO
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