Provider Demographics
NPI:1992949481
Name:CARELOCK, BENJAMIN WOERNER (DPM)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WOERNER
Last Name:CARELOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:W
Other - Last Name:CARELOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-0130
Mailing Address - Country:US
Mailing Address - Phone:970-858-2186
Mailing Address - Fax:
Practice Address - Street 1:281 N PLUM ST
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2100
Practice Address - Country:US
Practice Address - Phone:970-858-2530
Practice Address - Fax:970-858-1196
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000730213ES0103X
UT8606148-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery