Provider Demographics
NPI:1821327438
Name:BAKKAR, MOHAMMAD ASEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ASEM
Last Name:BAKKAR
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 1:1334 SAGE RIDGE ROAD
Mailing Address - Street 2:BOX 2614
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641
Mailing Address - Country:US
Mailing Address - Phone:206-930-5885
Mailing Address - Fax:425-930-5885
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:206-930-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT51262208600000X
CO56139208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery