Provider Demographics
NPI:1780644484
Name:BAER, DANIEL W (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:BAER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:EVANS 1650 COCHRANE CIRCLE
Mailing Address - Street 2:PAIN CLINIC
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-526-5033
Mailing Address - Fax:719-526-7377
Practice Address - Street 1:2020 N ACADEMY BLVD
Practice Address - Street 2:SUITE 155
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1567
Practice Address - Country:US
Practice Address - Phone:719-219-2350
Practice Address - Fax:719-219-0916
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COCO-DR-405242081P2900X
CO40524208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30158818Medicaid
BAB66248OtherBLUE CROSS BLUE SHIELD
CO806480Medicare Oscar/Certification
BAB66248OtherBLUE CROSS BLUE SHIELD
COH70205Medicare UPIN