Provider Demographics
NPI:1699969667
Name:PACINI, BERNARD R (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:R
Last Name:PACINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PATTERSON RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1953
Mailing Address - Country:US
Mailing Address - Phone:970-243-2479
Mailing Address - Fax:970-243-2481
Practice Address - Street 1:425 PATTERSON RD
Practice Address - Street 2:SUITE 406
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1953
Practice Address - Country:US
Practice Address - Phone:970-243-2479
Practice Address - Fax:970-243-2481
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22743207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22743OtherCOLORADO MED LICENCE
COD24151Medicare UPIN