Provider Demographics
NPI:1437241239
Name:BENZ, BECKY KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:KIM
Last Name:BENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 CARIBOU DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4325
Mailing Address - Country:US
Mailing Address - Phone:970-484-4757
Mailing Address - Fax:970-484-4759
Practice Address - Street 1:1024 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3929
Practice Address - Country:US
Practice Address - Phone:970-495-8600
Practice Address - Fax:970-495-7619
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND104622085R0202X
MN503782085R0202X
SD80172085R0202X
CODR.00532612085R0202X, 2085R0202X
WY9547A2085R0202X
NE277002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1437241239Medicaid
IDI73214Medicare UPIN
IDP01170326OtherMEDICARE
ID20002254Medicare PIN
ID20002255Medicare PIN