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DR. ROBERT BAZACO MD
Geriatric Medicine >> Family Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1487931770
Individual Registrant:DR. ROBERT BAZACO MD
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
2400 HIGHWAY 95 STE 50 BULLHEAD CITY, AZ 86442-7313 US
Tel: 928-444-8405 Fax: 928-299-5300
Tel: 928-444-8405 Fax: 928-299-5300
Contact information for business:
2400 HIGHWAY 95 STE 50 BULLHEAD CITY, AZ 86442-7313 US
Tel: 928-444-8405 Fax: 928-299-5300
Tel: 928-444-8405 Fax: 928-299-5300
Registration Information:
NPI: 1487931770
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 207QG0300X | Allopathic & Osteopathic Physicians Family Medicine Geriatric Medicine | AZ | 48283 |
| Y | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | AZ | 48283 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| AETNA | 7387955 | AZ | 01 |
| 879064 | AZ | 05 | |
| CIGNA | 3120998 | AZ | 01 |
