Healthcare Provider Details

I. General information

NPI: 1912904327
Provider Name (Legal Business Name): BRYAN G BAER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 LUTHERAN PKWY SUITE #380
WHEAT RIDGE CO
80033-6021
US

IV. Provider business mailing address

3555 LUTHERAN PKWY SUITE #380
WHEAT RIDGE CO
80033-6021
US

V. Phone/Fax

Practice location:
  • Phone: 303-940-8200
  • Fax: 303-940-8400
Mailing address:
  • Phone: 303-940-8200
  • Fax: 303-940-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number28172
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0028172
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: