# BENDER MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Miramont Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679912919
- **Authorized official:** JULIE M DESAIRE (CBDO)
- **Authorized official phone:** (970) 225-5107

## Contact information

- **Practice address:** 313 W DRAKE RD, FORT COLLINS, CO 80526-2846
- **Practice address phone:** (970) 482-8881
- **Practice address fax:** (970) 482-9646
- **Mailing address:** 313 W DRAKE RD, FORT COLLINS, CO 80526-2846
- **Mailing address phone:** (970) 482-8881
- **Mailing address fax:** (970) 482-9646

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 32679 | CO | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/20/2013
- **Last updated:** 02/10/2020