Provider Demographics
NPI:1558935015
Name:KEATON, BENJAMIN TRACE (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TRACE
Last Name:KEATON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14804 VIENNA CIR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5997
Mailing Address - Country:US
Mailing Address - Phone:801-913-3390
Mailing Address - Fax:
Practice Address - Street 1:7447 E BERRY AVE STE 100
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2103
Practice Address - Country:US
Practice Address - Phone:801-913-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72571204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM