Healthcare Provider Details

I. General information

NPI: 1275664096
Provider Name (Legal Business Name): VICTOR ANAYA BAEZ MD DABR BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/28/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

601 BROADWAY ST
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-3192
  • Fax:
Mailing address:
  • Phone: 303-602-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number18576
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0065892
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: