Provider Demographics
NPI:1649243726
Name:HACKETT, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:HACKETT
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 1:2525 N 8TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8845
Mailing Address - Country:US
Mailing Address - Phone:970-245-1168
Mailing Address - Fax:970-242-4299
Practice Address - Street 1:2525 N 8TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8845
Practice Address - Country:US
Practice Address - Phone:970-245-1168
Practice Address - Fax:970-242-4299
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21720207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01217207Medicaid
CO01217207Medicaid
COB4418Medicare ID - Type Unspecified