Provider Demographics
NPI:1285955534
Name:MENDOZA, BEN RYAN III (MD)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:RYAN
Last Name:MENDOZA
Suffix:III
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11160 HURON ST STE 31
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3335
Mailing Address - Country:US
Mailing Address - Phone:720-689-4151
Mailing Address - Fax:720-547-1562
Practice Address - Street 1:13845 BROADLANDS LN
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-9544
Practice Address - Country:US
Practice Address - Phone:720-689-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.52257207RB0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18758541Medicaid