Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 5943612-0501 | UT |
Y | 213ES0103X | Foot & Ankle Surgery | 665 | CO |
NPI | 1023172426 |
---|---|
Provider Name | Dr. Benjamin K Marble |
First Address | Pueblo, CO 81003-2657 |
Second Address | Pueblo, CO 81003-2657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19253044 | (05) | CO |
808770 | (02) | CO |
P00412290 | RAILROAD MEDICAR (01) | CO |