Healthcare Provider Details

I. General information

NPI: 1790984623
Provider Name (Legal Business Name): ROBERT JOHN OCHSNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 N ACADEMY BLVD
COLORADO SPRINGS CO
80918-3684
US

IV. Provider business mailing address

5731 N ACADEMY BLVD
COLORADO SPRINGS CO
80918-3684
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-3260
  • Fax:
Mailing address:
  • Phone: 719-445-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number053061
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberIMLC.MD.61015852
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101270615
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD0090402
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number53061
License Number StateCO
# 6
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number036160445
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: