| Doctor Name: | BENJAMIN GAINES |
| NPI Number: | 1710351127 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 0002099 |
| Business Practice Address: | 1056 W Broken Bow Dr Pueblo West, CO - 810074094 |
| Business Phone Number: | 2295487544 |
| Business Fax Number: | |
| Mailing Address: | 1056 W Broken Bow Dr, PUEBLO WEST |
| State: | CO |
| Postal Code: | 810074094 |
| Phone Number: | 2295487544 |
| Fax Number: | |
| NPI Enumeration Date: | 11/23/2015 |
| NPI Last Update Date: | 11/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225500000X |
| License Number: | 0002099 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals who are trained on a specific piece of equipment or technical procedure. |