MEDICARE: BENDER MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	32679	CO
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1679912919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENDER MEDICAL GROUP

Provider Business Mailing Address
First Line	:	313 W DRAKE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2846
Country	:	US
Telephone Number	:	970-482-8881
Fax Number	:	970-482-9646

Provider Business Practice Location Address
First Line	:	313 W DRAKE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2846
Country	:	US
Telephone Number	:	970-482-8881
Fax Number	:	970-482-9646

Authorized Official
Title or Position	:	CBDO
Name	:	JULIE M DESAIRE
Credential	:
Telephone Number	:	970-225-5107

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	02/10/2020

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