Individual
MR. ROBERT J BACON JR.
Active
Individual
MR. ROBERT J BACON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
F0861
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137509904
—
TX
05
—
137509907
—
TX
01
—
260034924
RR MEDICARE
TX
01
—
P00117827
RR MEDICARE
TX
Enumeration date
11/22/2006
Last updated
07/08/2020
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