Provider Demographics
NPI:1073508495
Name:SAMMONS, ROBERT ARDEL JR (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ARDEL
Last Name:SAMMONS
Suffix:JR
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:1400 N 7TH ST
Mailing Address - Street 2:MESA BEHAVIORAL MEDICINE CLINIC PC
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3004
Mailing Address - Country:US
Mailing Address - Phone:970-241-1983
Mailing Address - Fax:970-242-6135
Practice Address - Street 1:1400 N 7TH ST
Practice Address - Street 2:MESA BEHAVIORAL MEDICINE CLINIC PC
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3004
Practice Address - Country:US
Practice Address - Phone:970-241-1983
Practice Address - Fax:970-242-6135
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-09-03
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Provider Licenses
StateLicense IDTaxonomies
CO285792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28579OtherSTATE OF CO REGISTRATIONS
CO016862Medicaid
BS0652568OtherUS DEPT OF JUSTICE
CO28579OtherSTATE OF CO REGISTRATIONS
CO016862Medicaid