Provider Demographics
NPI:1194031070
Name:PENSACK, ROBERT JON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JON
Last Name:PENSACK
Suffix:
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 1:433 OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3813
Mailing Address - Country:US
Mailing Address - Phone:970-846-4057
Mailing Address - Fax:303-722-7857
Practice Address - Street 1:433 OGDEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3813
Practice Address - Country:US
Practice Address - Phone:970-846-4057
Practice Address - Fax:303-722-7857
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR 247442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry