Individual
ALVIN C BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
598 GREAT RD, LOWER LEVEL, NORTH SMITHFIELD, RI 02896-6810
(401) 534-6784
(401) 534-5460
Mailing address
33 CHAMBLY AVE, WARWICK, RI 02888-1805
(401) 534-6784
(401) 534-5460
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO 00461
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100801
UHC
—
01
—
2460971003
CIGNA
—
01
—
400400
BLUE CHIP
—
01
—
588384
AETNA
—
01
—
795932
USFHP
—
05
—
9025378
—
RI
Enumeration date
08/09/2006
Last updated
03/07/2012
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