Individual
DONALD L BADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FT DEFIANCE, AZ 86504-0589
(928) 729-8600
Mailing address
PO BOX 589, FT DEFIANCE INDIAN HOSPITAL BOARD, FORT DEFIANCE, AZ 86504-0589
(928) 729-8600
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
36859
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000S2505
—
NM
05
—
01368596
—
CO
01
—
930060672
RAILROAD
—
01
—
P00448188
RAILROAD MEDICARE PIN
CO
Enumeration date
07/14/2006
Last updated
10/27/2014
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