Provider Demographics
NPI:1649809989
Name:VAN BACKLE, ANN-SOPHIE (DO)
Entity type:Individual
Prefix:
First Name:ANN-SOPHIE
Middle Name:
Last Name:VAN BACKLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 N OGDEN ST STE 340
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3669
Mailing Address - Country:US
Mailing Address - Phone:303-318-3830
Mailing Address - Fax:
Practice Address - Street 1:1960 N OGDEN ST STE 340
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3669
Practice Address - Country:US
Practice Address - Phone:303-318-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5151014663207V00000X
CO0009369390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology