Basic Information
| Provider Information | |||||||||
| NPI: | 1316034465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | LAUREL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 S MONACO ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802373486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038612663 | ||||||||
| FaxNumber: | 3038614741 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 N HIGH ST | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802055503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038612663 | ||||||||
| FaxNumber: | 3038614741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 32390 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01323906 | 05 | CO | MEDICAID | 1316034465 | 05 | MT | MEDICAID | 1316034465 | 05 | SD | MEDICAID | 1316034465 | 05 | WY | MEDICAID | 100188830D | 05 | KS | MEDICAID | 10025633000 | 05 | NE | MEDICAID | 102258000 | 05 | WY | MEDICAID | 102258000WY | 05 | WY | MEDICAID |