Provider Demographics
NPI:1720062714
Name:YOUNG, BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:YOUNG
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 1:300 S JACKSON ST
Mailing Address - Street 2:STE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3183
Mailing Address - Country:US
Mailing Address - Phone:303-393-8050
Mailing Address - Fax:303-320-1953
Practice Address - Street 1:300 S JACKSON ST
Practice Address - Street 2:STE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3183
Practice Address - Country:US
Practice Address - Phone:303-321-0222
Practice Address - Fax:303-321-0222
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34102207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97789071Medicaid
CO469418Medicare ID - Type Unspecified
CO97789071Medicaid