Provider Demographics
NPI:1235220773
Name:SCHNURR, BENJAMIN BOE (DO)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BOE
Last Name:SCHNURR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 E ARAPAHOE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3703
Mailing Address - Country:US
Mailing Address - Phone:303-835-9915
Mailing Address - Fax:303-320-5399
Practice Address - Street 1:9620 E ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80112-3703
Practice Address - Country:US
Practice Address - Phone:303-835-9915
Practice Address - Fax:303-320-5399
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016019207Q00000X
NC2007-00332207Q00000X
CO48011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4929060Medicaid
COCO41111OtherMEDICARE PTAN
COCO41111OtherMEDICARE PTAN
MIC36132046Medicare PIN