Provider Demographics
NPI:1912904327
Name:BAER, BRYAN G (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:G
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 1:3555 LUTHERAN PKWY
Mailing Address - Street 2:SUITE #380
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6021
Mailing Address - Country:US
Mailing Address - Phone:303-940-8200
Mailing Address - Fax:303-940-8400
Practice Address - Street 1:3555 LUTHERAN PKWY
Practice Address - Street 2:SUITE #380
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6021
Practice Address - Country:US
Practice Address - Phone:303-940-8200
Practice Address - Fax:303-940-8400
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28172174400000X
CODR.0028172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39023389Medicaid
COBA05301OtherANTHEM INDIVIDUAL
CO4134658OtherAETNA
CO800330000OtherTRICARE
COBA05301OtherANTHEM GROUP
CO841749744001OtherRMHP
CO01271724Medicaid
CO84091995302OtherPACIFICARE
CO020040609OtherMEDICARE RAILROAD
CO39023389Medicaid
CO841749744001OtherRMHP