Individual
DR. CELSO LUIZ BACKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
(814) 274-7101
(814) 274-3251
Mailing address
1001 EAST SECOND STREET, COUDERSPORT, PA 16915
(814) 274-7101
(814) 274-3251
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD035343L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006289620002
—
PA
01
—
BA159071
BLUE SHIELD
—
Enumeration date
11/21/2006
Last updated
12/01/2011
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