Provider Demographics
NPI:1508055237
Name:BRYAN G BAER, MD, PROF LLC
Entity Type:Organization
Organization Name:BRYAN G BAER, MD, PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-467-8991
Mailing Address - Street 1:8550 W 38TH AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4300
Mailing Address - Country:US
Mailing Address - Phone:303-467-8991
Mailing Address - Fax:303-467-9510
Practice Address - Street 1:8550 W 38TH AVE
Practice Address - Street 2:STE 205
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4300
Practice Address - Country:US
Practice Address - Phone:303-467-8991
Practice Address - Fax:303-467-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28172174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39023389Medicaid