Healthcare Provider Details

I. General information

NPI: 1710474952
Provider Name (Legal Business Name): IAN ALEXANDER BACKLUND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 BANNOCK ST
DENVER CO
80204-4506
US

IV. Provider business mailing address

1215 LEE ST # 801016
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4949
  • Fax: 303-602-4560
Mailing address:
  • Phone: 434-243-0270
  • Fax: 434-243-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1710474952
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0070122
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: