Organization
DONNA L BACON MD PA
Active
Other names
Donna L Bacon, MD, PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONNA L BACON MD (PRESIDENT)
(321) 631-3693
Entity
Organization
Contact information
Practice address
1282 US HIGHWAY 1 STE 1, ROCKLEDGE, FL 32955-2747
(321) 631-3693
(321) 631-7618
Mailing address
1282 US HIGHWAY 1 STE 1, ROCKLEDGE, FL 32955-2747
(321) 631-3693
(321) 631-7618
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME71719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101544100
—
FL
01
—
ME71719
MEDICAL LIC
FL
Enumeration date
03/30/2009
Last updated
10/31/2023
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