Provider Demographics
NPI:1972573954
Name:AUSTIN, WILLIAM BENNETT III (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENNETT
Last Name:AUSTIN
Suffix:III
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 1:2637 MIDPOINT DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4408
Mailing Address - Country:US
Mailing Address - Phone:970-488-1666
Mailing Address - Fax:970-472-9381
Practice Address - Street 1:2637 MIDPOINT DR STE B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4408
Practice Address - Country:US
Practice Address - Phone:970-488-1666
Practice Address - Fax:970-472-9381
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42642207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69051038Medicaid
COP00630800OtherRAILROAD MEDICARE
COC808871Medicare PIN