Individual
MELISSA M BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
113 MCRAE PT, MADISON, MS 39110-6579
(507) 250-7030
Mailing address
113 MCRAE PT, MADISON, MS 39110-6579
(507) 250-7030
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
24598
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09336744
—
MS
Enumeration date
08/25/2006
Last updated
02/22/2017
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