Individual
DR. ROSS NOEL BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1205 S GRANGE AVE STE 407, SIOUX FALLS, SD 57105-0410
(605) 328-8900
(605) 328-8901
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
(605) 328-6512
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
28247
IA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
28247
IA
207RP1001X
Pulmonary Disease Physician
28247
IA
207RP1001X
Pulmonary Disease Physician
Primary
4302
SD
207RS0012X
Sleep Medicine (Internal Medicine) Physician
28247
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10025572500
MEDICAID
NE
01
—
4992607
BLUE CROSS BLUE SHIELD
SD
01
—
71249
BLUE CROSS BLUE SHIELD
IA
Enumeration date
10/27/2006
Last updated
08/22/2013
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