Individual ProviderRoy M. BakAnesthesiologyAllopathic & Osteopathic PhysiciansPractice Address101 W 8th Ave, Spokane, WA 99204-2307(509) 474-3181PECOS EnrollmentThis provider is enrolled in PECOS as ROY BAK.Based on the most recent information from CMS, provider Roy M. Bak is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1225046352Provider TypeIndividualFull NameBak, Roy M.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date8/4/2006Last Updated9/18/2024Contact InformationPractice LocationPractice Address101 W 8th Ave, Spokane, WA 99204-2307Phone(509) 474-3181Fax(509) 598-2129Mailing LocationMailing Address101 W 8th Ave, Spokane, WA 99204-2307Phone(509) 474-3181Fax(509) 598-2129Provider TaxonomiesCodeDescriptionLicenseCode207L00000XPrimaryDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicenseA79654CaliforniaCode207L00000XDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicense100064AlaskaCode207L00000XDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicense036-167022IllinoisCode207L00000XDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicense4127-320WisconsinCode207L00000XDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicenseMD61096343WashingtonProvider IdentifiersIDDescriptionIssuerID00A796540DescriptionMedicaidIssuerUnlistedCaliforniaID00A796540DescriptionOtherIssuerBLUE SHIELD OF CACalifornia