Provider Demographics
NPI:1417963943
Name:JENSEN, HARRIS ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:ROBERT
Last Name:JENSEN
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 1:1019 REMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3711
Mailing Address - Country:US
Mailing Address - Phone:970-416-8354
Mailing Address - Fax:970-416-0354
Practice Address - Street 1:1019 REMINGTON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3711
Practice Address - Country:US
Practice Address - Phone:970-416-8354
Practice Address - Fax:970-416-0354
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO353072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1353077Medicaid
CO46321Medicare ID - Type Unspecified
CO1353077Medicaid