Provider Demographics
NPI:1205279650
Name:BACH, LOREN NATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:NATHAN
Last Name:BACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 560A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8261
Mailing Address - Country:US
Mailing Address - Phone:314-251-6440
Mailing Address - Fax:314-251-4456
Practice Address - Street 1:621 S NEW BALLAS RD STE 560A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-6440
Practice Address - Fax:314-251-4456
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59069208600000X, 207T00000X
390200000X
MO2019029089208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program