Healthcare Provider Details

I. General information

NPI: 1003895293
Provider Name (Legal Business Name): IAN SEBASTIAN BACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19964 HILLTOP RD STE A
PARKER CO
80134-7316
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 303-841-2212
  • Fax: 303-841-4716
Mailing address:
  • Phone: 970-624-4123
  • Fax: 970-624-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35490
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: