Basic Information
| Provider Information | |||||||||
| NPI: | 1003895293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACH | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | SEBASTIAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ELDORADO BLVD STE 6250 | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800213421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032720768 | ||||||||
| FaxNumber: | 3033182488 | ||||||||
| Practice Location | |||||||||
| Address1: | 12169 SHERIDAN BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800202459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036039400 | ||||||||
| FaxNumber: | 3036039420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2006 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35490 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080186089 | 01 | CO | RAILROAD MEDICARE # | OTHER | 1003895293 | 01 | CO | NPI # | OTHER | 01354901 | 05 | CO | MEDICAID | 04020541 | 05 | CO | MEDICAID | 1215981634 | 01 | CO | GROUP NPI # | OTHER | 276029 | 01 | CO | CIGNA | OTHER | 84136530263 | 01 | CO | PACIFICARE PPO | OTHER | BA645053 | 01 | CO | ANTHEM BCBS | OTHER | RO103008 | 01 | CO | GROUP ANTHEM BCBS | OTHER | 7201056 | 01 | CO | AETNA | OTHER | 841365302036 | 01 | CO | RKY MTN HMO | OTHER | 84136530238 | 01 | CO | PACIFICARE | OTHER |