Provider Demographics
NPI:1932513900
Name:BACA, DAVID ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:BACA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2705
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:601 W 5TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2705
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60467039363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical