Provider Demographics
NPI:1710962758
Name:BACH, ALLAN W (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:W
Last Name:BACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 N CIRCLE DR
Mailing Address - Street 2:#100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1174
Mailing Address - Country:US
Mailing Address - Phone:719-632-7669
Mailing Address - Fax:719-632-0088
Practice Address - Street 1:3010 N CIRCLE DR
Practice Address - Street 2:#100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1174
Practice Address - Country:US
Practice Address - Phone:719-632-7669
Practice Address - Fax:719-632-0088
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36933207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01369339Medicaid
S2448Medicare ID - Type Unspecified
CO01369339Medicaid