Individual
DR. JOSHUA BENJAMIN BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4345 NELSON RD STE 102, LAKE CHARLES, LA 70605-4183
(337) 480-7900
(337) 602-6358
Mailing address
PO BOX 123594 DEPT 3594, DALLAS, TX 75312-0001
(337) 494-2772
(337) 494-2928
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
323354
LA
Other
Enumeration date
06/09/2017
Last updated
04/27/2022
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