Provider Demographics
NPI:1003258047
Name:BACHMANN, JEANETTE MASON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MASON
Last Name:BACHMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANNE
Other - Middle Name:JEANETTE
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5060 HIDDEN ROCK RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-2062
Mailing Address - Country:US
Mailing Address - Phone:719-495-3960
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:
Practice Address - City:US AIR FORCE
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics