Healthcare Provider Details

I. General information

NPI: 1417481367
Provider Name (Legal Business Name): GREGORY HARRIS BACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 59TH ST W STE 2200
BRADENTON FL
34209-4689
US

IV. Provider business mailing address

2020 59TH ST W STE 2200
BRADENTON FL
34209-4604
US

V. Phone/Fax

Practice location:
  • Phone: 941-794-5621
  • Fax:
Mailing address:
  • Phone: 941-794-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME150196
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME150196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: