Provider Demographics
NPI:1588925044
Name:WHITE, BENJAMIN HARROLD (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HARROLD
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13822 W 68TH WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-1103
Mailing Address - Country:US
Mailing Address - Phone:347-227-9230
Mailing Address - Fax:
Practice Address - Street 1:3303 W 144TH AVE UNIT 103
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-9464
Practice Address - Country:US
Practice Address - Phone:303-425-9245
Practice Address - Fax:720-630-8591
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0058604207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program