Provider Demographics
NPI:1750356473
Name:BOGENBERGER, ROBERT PAUL
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:BOGENBERGER
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 1:2185 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2534
Mailing Address - Country:US
Mailing Address - Phone:303-296-2244
Mailing Address - Fax:303-296-1709
Practice Address - Street 1:2000 LITTLE RAVEN ST
Practice Address - Street 2:UNIT 502
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202
Practice Address - Country:US
Practice Address - Phone:303-817-3672
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY 1840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC65916OtherMEDICARE
CO07020225Medicaid
CO07020225Medicaid