Individual
MICHAEL L BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 WEST RAVINE ROAD, KINGSPORT, TN 37662
(423) 224-4000
(423) 224-5120
Mailing address
PO BOX 11724, KNOXVILLE, TN 37939-1724
(865) 766-8800
(865) 766-8874
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
23688
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3072071
—
TN
Enumeration date
06/16/2006
Last updated
09/26/2011
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