Healthcare Provider Details

I. General information

NPI: 1649252719
Provider Name (Legal Business Name): BERNARD R PACINI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PATTERSON SUITE 406
GRAND JCT CO
81506-1910
US

IV. Provider business mailing address

425 PATTERSON SUITE 406
GRAND JCT CO
81506-1910
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-2479
  • Fax: 970-243-2481
Mailing address:
  • Phone: 970-243-2479
  • Fax: 970-243-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number22743
License Number StateCO

VIII. Authorized Official

Name: DR. BERNARD RALPH PACINI
Title or Position: PRESIDENT
Credential: MD
Phone: 970-243-2479