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Individual
CARL WILLIAM BACON
Active
Individual
CARL WILLIAM BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
181471-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-00096
UTAH HEALTHCARE
UT
01
—
107007443103
IHC
UT
01
—
20045128
PALMETTO
UT
01
—
68078
PEHP
UT
01
—
870281028BAC
EMIA
UT
Enumeration date
09/07/2006
Last updated
11/27/2023
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