Provider Demographics
NPI:1962653006
Name:BENISH, BETHANY JEAN (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JEAN
Last Name:BENISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:JEAN
Other - Last Name:GANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:MC 0218
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204
Mailing Address - Country:US
Mailing Address - Phone:303-602-1105
Mailing Address - Fax:303-436-6548
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:MC 0218
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-602-1105
Practice Address - Fax:303-436-6548
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51195207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology