1912904327 NPI number — BRYAN G BAER MD

Table of content: BRYAN G BAER MD (NPI 1912904327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912904327 NPI number — BRYAN G BAER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAER
Provider First Name:
BRYAN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912904327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3555 LUTHERAN PKWY
Provider Second Line Business Mailing Address:
SUITE #380
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80033-6021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-940-8200
Provider Business Mailing Address Fax Number:
303-940-8400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3555 LUTHERAN PKWY
Provider Second Line Business Practice Location Address:
SUITE #380
Provider Business Practice Location Address City Name:
WHEAT RIDGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80033-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-940-8200
Provider Business Practice Location Address Fax Number:
303-940-8400
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  28172 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: DR.0028172 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39023389 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: BA05301 . This is a "ANTHEM INDIVIDUAL" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 4134658 . This is a "AETNA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 800330000 . This is a "TRICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: BA05301 . This is a "ANTHEM GROUP" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 841749744001 . This is a "RMHP" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01271724 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84091995302 . This is a "PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 020040609 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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