Provider Demographics
NPI:1386137537
Name:BAHN, AGNES CARSEN EILEEN (MD)
Entity type:Individual
Prefix:DR
First Name:AGNES CARSEN
Middle Name:EILEEN
Last Name:BAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:820 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4714
Mailing Address - Country:US
Mailing Address - Phone:307-632-2434
Mailing Address - Fax:
Practice Address - Street 1:151 W LAKE ST STE 1500
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4124
Practice Address - Country:US
Practice Address - Phone:970-305-5210
Practice Address - Fax:970-823-9001
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY12999A207Q00000X
CODR.0068987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine