Provider Demographics
NPI:1689713398
Name:BENGFORT, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:BENGFORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1215 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3239
Mailing Address - Country:US
Mailing Address - Phone:719-598-7741
Mailing Address - Fax:719-598-1972
Practice Address - Street 1:175 S UNION BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3126
Practice Address - Country:US
Practice Address - Phone:719-365-6363
Practice Address - Fax:719-365-5801
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO21658207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52489329Medicaid
CO52489329Medicaid
COC389068Medicare ID - Type Unspecified