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Individual
IRIS BACCAM
Active
Individual
IRIS BACCAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2025003070
MO
207Q00000X
Family Medicine Physician
67162
AZ
207Q00000X
Family Medicine Physician
A180724
CA
207Q00000X
Family Medicine Physician
Primary
U5921
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2019
Last updated
09/23/2026
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