Healthcare Provider Details

I. General information

NPI: 1215940838
Provider Name (Legal Business Name): HAROLD G BACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 OKEECHOBEE BLVD
WEST PALM BEACH FL
33411
US

IV. Provider business mailing address

450 N FEDERAL HWY #1105
BOYNTON BEACH FL
33435-4184
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-1111
  • Fax: 561-967-3144
Mailing address:
  • Phone: 954-573-0372
  • Fax: 561-967-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME98091
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: