Healthcare Provider Details

I. General information

NPI: 1023403623
Provider Name (Legal Business Name): LAURA ELIZABETH BACH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DUKE MEDICINE CIR
DURHAM NC
27710-4000
US

IV. Provider business mailing address

40 DUKE MEDICINE CIR
DURHAM NC
27710-4000
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-6437
  • Fax:
Mailing address:
  • Phone: 919-684-6437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number009022
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125066428
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: