MEDICARE: DANIEL W BAER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	CO-DR-40524	CO
2	208100000X	Physical Medicine & Rehabilitation Physician	40524	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	BAB66248	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1780644484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL W BAER D.O.

Provider Business Mailing Address
First Line	:	EVANS 1650 COCHRANE CIRCLE
Second Line	:	PAIN CLINIC
City	:	FORT CARSON
State	:	CO
Zip	:	80913
Country	:	US
Telephone Number	:	719-526-5033
Fax Number	:	719-526-7377

Provider Business Practice Location Address
First Line	:	2020 N ACADEMY BLVD
Second Line	:	SUITE 155
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:	719-219-2350
Fax Number	:	719-219-0916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	04/08/2021

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