Provider Demographics
NPI:1104822121
Name:HENSON, ROBERT ELLIS II (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ELLIS
Last Name:HENSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5961 RAIN DANCE TRL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80125-9095
Mailing Address - Country:US
Mailing Address - Phone:720-255-4134
Mailing Address - Fax:720-784-6183
Practice Address - Street 1:5961 RAIN DANCE TRL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-9095
Practice Address - Country:US
Practice Address - Phone:720-255-4134
Practice Address - Fax:720-784-6183
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60700596207RC0000X
CO30651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104822121Medicaid
CO300801Medicare PIN
CO1306513Medicaid