Provider Demographics
NPI:1063549749
Name:OBERBECK, GLORIA PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:PATRICIA
Last Name:OBERBECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:PATRICIA
Other - Last Name:BACHELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-0445
Mailing Address - Country:US
Mailing Address - Phone:303-828-9200
Mailing Address - Fax:303-828-9204
Practice Address - Street 1:636 KATTELL ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-0445
Practice Address - Country:US
Practice Address - Phone:303-828-9200
Practice Address - Fax:303-828-9204
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803326OtherMEDICARE GROUP PIN
COC803325Medicare PIN
COC803326OtherMEDICARE GROUP PIN