Individual
DR. OLIVER M.L. BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 PARNASSUS AVE # 429, SAN FRANCISCO, CA 94143-2202
(415) 353-2119
(415) 353-2406
Mailing address
1635 DIVISADERO ST, SUITE 625, BOX 1821, SAN FRANCISCO, CA 94143-0001
(415) 476-4029
(415) 476-4150
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A73008
CA
207RI0200X
Infectious Disease Physician
Primary
A73008
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A730080
—
CA
Enumeration date
08/25/2006
Last updated
01/10/2012
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