=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063682375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLORIA BACHELDER MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2008
-----------------------------------------------------
Last Update Date | 05/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636 KATTELL STREET
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80516-0445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-828-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 445 636 KATTELL STREET
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80516-0445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-828-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GLORIA BACHELDER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 303-828-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 32141
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------