Provider Demographics
NPI:1891829545
Name:GRELLER, BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:GRELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-716-8026
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:1707 COLE BLVD
Practice Address - Street 2:STE 250
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3220
Practice Address - Country:US
Practice Address - Phone:303-716-8026
Practice Address - Fax:303-763-5495
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine