Individual
KENNETH TERRY BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8038 MESA DR, AUSTIN, TX 78731-1319
(512) 901-8748
Mailing address
12221 MOPAC EXPRESSWAY NORTH, AUSTIN, TX 78758-2483
(512) 901-8748
(512) 901-8755
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D5902
TX
Other
Enumeration date
12/22/2005
Last updated
03/04/2008
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