Individual
DR. JEFFREY KYLE BACON
Active
Individual
DR. JEFFREY KYLE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
20A11715
CA
207RR0500X
Rheumatology Physician
Primary
20A11715
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101340
—
CA
01
—
1265783948
GROUP NPI
CA
01
—
CB206701
CMS NORIDIAN
CA
01
—
DT5405
RR MEDICARE PTAN
—
01
—
GU585A
CMS NORIDIAN
CA
Enumeration date
04/13/2007
Last updated
08/02/2022
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