Provider Demographics
NPI:1255388740
Name:BACHRACH, BERT E (MD)
Entity type:Individual
Prefix:
First Name:BERT
Middle Name:E
Last Name:BACHRACH
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:1101 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-6921
Practice Address - Fax:573-884-8823
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003017173208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO182938OtherBLUE SHIELD
MO3300196OtherUNITED HEALTH CARE
MO620961OtherHEALTHLINK
MO182938OtherBLUE CHOICE
MO209233907Medicaid
MO209233907Medicaid