Provider Demographics
NPI:1992288559
Name:BENJAMIN, ROBERT COLE (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:COLE
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:PA-C
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 10100
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-0008
Mailing Address - Country:US
Mailing Address - Phone:970-874-7681
Mailing Address - Fax:
Practice Address - Street 1:70 STAFFORD LN SUITE A
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416
Practice Address - Country:US
Practice Address - Phone:970-874-6008
Practice Address - Fax:970-546-4033
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005517363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1417935446OtherDELTA COUNTY MEMORIAL HOSPITAL NPI
CO1629521539OtherDELTA HEALTH URGENT CARE AND BEHAVIORAL HEALTH CENTER NPI