Provider Demographics
NPI:1275753519
Name:BENNETT, DANA RANSOM (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:RANSOM
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:121 S CRESCENT DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5433
Practice Address - Country:US
Practice Address - Phone:719-595-7575
Practice Address - Fax:719-547-8368
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2016-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO21659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01216597Medicaid
CO01216597Medicaid
CO01216597Medicaid