Provider Demographics
NPI:1740269067
Name:BACH, PERRY BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:BERNARD
Last Name:BACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12620 OLD PUEBLO RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-3717
Mailing Address - Country:US
Mailing Address - Phone:719-382-6667
Mailing Address - Fax:719-546-4770
Practice Address - Street 1:12620 OLD PUEBLO RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-3717
Practice Address - Country:US
Practice Address - Phone:719-382-6667
Practice Address - Fax:719-546-4770
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO295422084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF24589Medicare UPIN