Healthcare Provider Details

I. General information

NPI: 1689671539
Provider Name (Legal Business Name): KEVIN E BACHUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 E ELIZABETH ST
FORT COLLINS CO
80524-3953
US

IV. Provider business mailing address

1080 E ELIZABETH ST
FORT COLLINS CO
80524-3953
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-6353
  • Fax: 970-493-6366
Mailing address:
  • Phone: 970-493-6353
  • Fax: 970-493-6366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number27514
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number27514
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: