Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | DR.0059782 | CO |
N | 208000000X | Pediatrician | 14674 | NH |
N | 208000000X | Pediatrician | 65996 | GA |
N | 208000000X | Pediatrician | N4944 | TX |
NPI | 1134347669 |
---|---|
Provider Name | Jacob David Beniflah |
First Address | Denver, CO 80217-0284 |
Second Address | Denver, CO 80218-1235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2007 |
Last Update Date | 28/03/2018 |