Provider Demographics
NPI:1801019534
Name:BEHRENDTSEN, OLE
Entity Type:Individual
Prefix:DR
First Name:OLE
Middle Name:
Last Name:BEHRENDTSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CAMINO DEL REMEDIO
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1332
Mailing Address - Country:US
Mailing Address - Phone:805-681-5450
Mailing Address - Fax:
Practice Address - Street 1:315 CAMINO DEL REMEDIO
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1332
Practice Address - Country:US
Practice Address - Phone:805-681-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR6903207R00000X
IA37227207R00000X, 2084P0800X
CAA1112472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA56589OtherWELLMARK BCBS
IAP00411059OtherRAILROAD MEDICARE
IAI20506Medicare PIN