Individual
MR. PAUL R. K. BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
138 KINOOLE ST, HILO, HI 96720-2816
(808) 933-0599
(808) 933-0585
Mailing address
15-2809 MAIKO ST, PAHOA, HI 96778-9136
(808) 933-0598
(808) 933-0585
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
539372-15
—
HI
Enumeration date
02/23/2007
Last updated
07/09/2007
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