Healthcare Provider Details

I. General information

NPI: 1629035266
Provider Name (Legal Business Name): JUDY C BAACK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGE GATE PKWY #290
LONE TREE CO
80124
US

IV. Provider business mailing address

PO BOX 261577
LITTLETON CO
80163-1577
US

V. Phone/Fax

Practice location:
  • Phone: 303-791-2112
  • Fax: 303-683-6415
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number31755
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: