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General NPI Number Information
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NPI Number | 1548587900
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Entity Type | Individual
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Provider Name | JONATHON DAVID BACKUS MD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 181 W MEADOW DR STE 400
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City | VAIL
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State | CO
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Zip | 81657-5058
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Country | US
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Telephone | 970-476-1100
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Fax | 970-479-5835
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Provider Business Mailing Address
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Address Line | 181 W MEADOW DR STE 400
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City | VAIL
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State | CO
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Zip | 81657-5058
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Country | US
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Telephone | 970-476-1100
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Fax | 970-479-5845
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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 | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | 2019009680
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | 0054772
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License Number State | CO
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