Individual
WILLIAM RUSSELL BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11995 SINGLETREE LN STE 500, EDEN PRAIRIE, MN 55344-5349
(952) 595-1301
(612) 294-4903
Mailing address
11995 SINGLETREE LN STE 500, EDEN PRAIRIE, MN 55344-5349
(952) 595-1301
(612) 294-4903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
47338
TN
2085R0202X
Diagnostic Radiology Physician
Primary
ME151240
FL
Other
Enumeration date
02/02/2009
Last updated
08/01/2022
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