Individual
DR. GEOFFREY BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 ENTERPRISE PARKWAY, SUITE 300, HAMPTON, VA 23666-2583
(757) 825-2500
(757) 825-2521
Mailing address
901 ENTERPRISE PKWY, SUITE 300, HAMPTON, VA 23666-6249
(757) 825-2500
(757) 825-2521
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
0101048019
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006502415
—
VA
01
—
235056
ANTHEM
VA
Enumeration date
07/29/2005
Last updated
04/09/2020
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