Individual
DR. GREGORY K BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
464 CENTRAL AVE, SUITE 4, LOS ALAMOS, NM 87544-3350
(505) 795-5217
(505) 747-9696
Mailing address
112 GRAND CANYON DR, LOS ALAMOS, NM 87544-3423
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
Primary
MD2008-0553
NM
Other
Enumeration date
11/16/2006
Last updated
01/31/2014
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