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General NPI Number Information
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NPI Number | 1003895293
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Entity Type | Individual
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Provider Name | IAN SEBASTIAN BACH MD
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Gender | Male
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 19964 HILLTOP RD STE A
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City | PARKER
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State | CO
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Zip | 80134-7316
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Country | US
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Telephone | 303-841-2212
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Fax | 303-841-4716
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Provider Business Mailing Address
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Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
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City | LOVELAND
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State | CO
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Zip | 80538-9071
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Country | US
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Telephone | 970-624-4123
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Fax | 970-624-2416
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35490
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License Number State | CO
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