Individual
DOUGLAS RICHARD BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(507) 284-2511
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
23453
MS
207L00000X
Anesthesiology Physician
Primary
42805
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05236703
—
MS
05
—
094957400
—
MN
Enumeration date
01/20/2006
Last updated
07/11/2022
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