Provider Demographics
NPI:1215099965
Name:BENSON, LOUISE E (MD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:E
Last Name:BENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0327
Mailing Address - Country:US
Mailing Address - Phone:303-657-2763
Mailing Address - Fax:303-657-9023
Practice Address - Street 1:3308 W 11TH AVENUE PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-6764
Practice Address - Country:US
Practice Address - Phone:303-439-2259
Practice Address - Fax:303-469-9331
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30485207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC08531Medicare ID - Type Unspecified
COF16332Medicare UPIN