Provider Demographics
NPI:1760649024
Name:COURTNEY, ROBERT JACKSON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JACKSON
Last Name:COURTNEY
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 1:8101 E LOWRY BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7195
Mailing Address - Country:US
Mailing Address - Phone:303-261-1600
Mailing Address - Fax:303-261-1601
Practice Address - Street 1:1050 W SOUTH BOULDER RD STE 2100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2818
Practice Address - Country:US
Practice Address - Phone:303-261-1600
Practice Address - Fax:303-261-1601
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53928207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51008815Medicaid
CO365469ZJH2Medicare PIN