Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | J8900 | TX |
NPI | 1003258047 |
---|---|
Provider Name | Dr. Jeanette Mason Bachmann |
First Address | Colorado Springs, CO 80908-2062 |
Second Address | Us Air Force, CO 80840-2502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2013 |
Last Update Date | 18/07/2013 |