Provider Demographics
NPI:1720837990
Name:POLK, ROBERT L JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:POLK
Suffix:JR
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 1:4350 S IDALIA WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4424
Mailing Address - Country:US
Mailing Address - Phone:469-416-5953
Mailing Address - Fax:
Practice Address - Street 1:4350 S IDALIA WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-4424
Practice Address - Country:US
Practice Address - Phone:469-416-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician