Individual
JONATHAN P BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
78 DOLPHIN POINT DR, BEAUFORT, SC 29907-1715
(253) 722-4909
Mailing address
78 DOLPHIN POINT DR, BEAUFORT, SC 29907-1715
(253) 722-4909
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD00021515
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016591
—
WA
Enumeration date
12/21/2006
Last updated
03/26/2018
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