Provider Demographics
NPI:1780690487
Name:BAACK, BRET (MD)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:BAACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1120 E ELIZABETH ST
Mailing Address - Street 2:G-2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4044
Mailing Address - Country:US
Mailing Address - Phone:970-484-6303
Mailing Address - Fax:970-484-6908
Practice Address - Street 1:1120 E ELIZABETH ST
Practice Address - Street 2:G-2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4044
Practice Address - Country:US
Practice Address - Phone:970-484-6303
Practice Address - Fax:970-484-6908
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM90-145208200000X
CO51164207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery