Healthcare Provider Details

I. General information

NPI: 1225942386
Provider Name (Legal Business Name): RAJAN S BAWA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 GRAY FOX RD
FORT COLLINS CO
80526-5266
US

IV. Provider business mailing address

4414 GRAY FOX RD
FORT COLLINS CO
80526-5266
US

V. Phone/Fax

Practice location:
  • Phone: 970-214-1588
  • Fax:
Mailing address:
  • Phone: 970-214-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: