Individual
DR. BENEDICT GBOLABO FAMORI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
106 BLANCA AVE, ALAMOSA, CO 81101-2340
(719) 589-2511
(719) 587-1372
Mailing address
106 BLANCA AVE, ALAMOSA, CO 81101-2340
(719) 589-2511
(719) 587-1372
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C1-0012550
DE
208M00000X
Hospitalist Physician
46889
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1076830
—
LA
05
—
18807313
—
CO
Enumeration date
10/02/2007
Last updated
06/15/2018
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