Individual
EDWIN L BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4323 INTEGRITY CENTER PT, COLORADO SPRINGS, CO 80917-1683
(719) 591-2558
(719) 591-2596
Mailing address
2695 ROCKY MOUNTAIN AVE, STE 150, LOVELAND, CO 80538-9071
(970) 624-4036
(970) 490-4378
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR.0045333
CO
2083X0100X
Occupational Medicine Physician
45333
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70036586
—
CO
Enumeration date
04/25/2007
Last updated
07/28/2016
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