Individual
BENJAMIN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1025 PENNOCK PL, FORT COLLINS, CO 80524-3257
(970) 495-8800
Mailing address
1025 PENNOCK PL, FORT COLLINS, CO 80524-3257
(970) 495-8800
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR.0057228
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21125104
—
CO
Enumeration date
04/23/2015
Last updated
04/29/2022
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