Healthcare Provider Details

I. General information

NPI: 1104822121
Provider Name (Legal Business Name): ROBERT ELLIS HENSON II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5961 RAIN DANCE TRL
LITTLETON CO
80125-9095
US

IV. Provider business mailing address

5961 RAIN DANCE TRL
LITTLETON CO
80125-9095
US

V. Phone/Fax

Practice location:
  • Phone: 720-255-4134
  • Fax: 720-784-6183
Mailing address:
  • Phone: 720-255-4134
  • Fax: 720-784-6183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60700596
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30651
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: