Provider Demographics
NPI:1457336737
Name:BEHEN, EDWARD N (DPM)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:N
Last Name:BEHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7423
Mailing Address - Country:US
Mailing Address - Phone:970-245-1579
Mailing Address - Fax:970-245-1582
Practice Address - Street 1:2217 N 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7423
Practice Address - Country:US
Practice Address - Phone:970-245-1579
Practice Address - Fax:970-241-5158
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO295213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA1503OtherBCBS
CO01002955Medicaid
COT60223Medicare UPIN
CO4800042089Medicare PIN
COA1503OtherBCBS