Provider Demographics
NPI:1578505343
Name:HAENSCHEN, RODNEY JAMES (DO)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:JAMES
Last Name:HAENSCHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 SILVER FOX RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5268
Mailing Address - Country:US
Mailing Address - Phone:970-266-1497
Mailing Address - Fax:
Practice Address - Street 1:2803 SILVER FOX RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5268
Practice Address - Country:US
Practice Address - Phone:970-266-1497
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36081207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C39600Medicare UPIN