Individual
CHRISTOPHER GLENN BACAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4801 ALBERTA AVE, EL PASO, TX 79905-2707
(915) 215-4360
Mailing address
4801 ALBERTA AVE, EL PASO, TX 79905-2707
(915) 215-5700
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
BP10081683
TX
Other
Enumeration date
04/21/2022
Last updated
07/20/2022
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