Provider Demographics
NPI:1972505907
Name:BAER, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:BAER
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 1:6705 RANGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7300
Mailing Address - Country:US
Mailing Address - Phone:719-599-7331
Mailing Address - Fax:719-390-1333
Practice Address - Street 1:6705 RANGEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7300
Practice Address - Country:US
Practice Address - Phone:719-599-7331
Practice Address - Fax:719-390-1333
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2014-12-30
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CO37035174400000X
COCO37035207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01370352Medicaid
CO01370352Medicaid
I23499Medicare UPIN