=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104822121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT ELLIS HENSON II MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2005
-----------------------------------------------------
Last Update Date | 01/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5961 RAIN DANCE TRL
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80125-9095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-255-4134
-----------------------------------------------------
Fax | 720-784-6183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5961 RAIN DANCE TRL
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80125-9095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-255-4134
-----------------------------------------------------
Fax | 720-784-6183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD60700596
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 30651
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------