MEDICARE: DR. PERRY BERNARD BACH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	29542	CO
2	2084P0804X	Child & Adolescent Psychiatry Physician	29542	CO

General Provider Information

NPI Number	:	1740269067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PERRY BERNARD BACH M.D.

Provider Business Mailing Address
First Line	:	12620 OLD PUEBLO RD
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-3717
Country	:	US
Telephone Number	:	719-382-6667
Fax Number	:	719-546-4770

Provider Business Practice Location Address
First Line	:	12620 OLD PUEBLO RD
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-3717
Country	:	US
Telephone Number	:	719-382-6667
Fax Number	:	719-546-4770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	09/11/2025

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