Healthcare Provider Details

I. General information

NPI: 1780644484
Provider Name (Legal Business Name): DANIEL W BAER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 04/08/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 N ACADEMY BLVD SUITE 155
COLORADO SPRINGS CO
80909-1567
US

IV. Provider business mailing address

EVANS 1650 COCHRANE CIRCLE PAIN CLINIC
FORT CARSON CO
80913
US

V. Phone/Fax

Practice location:
  • Phone: 719-219-2350
  • Fax: 719-219-0916
Mailing address:
  • Phone: 719-526-5033
  • Fax: 719-526-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberCO-DR-40524
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number40524
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: