Organization
JEFFREY P BACON
Active
Other names
GRANITE PULMONARY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P BACON MD (OWNER)
(916) 305-6345
Entity
Organization
Contact information
Practice address
5442 LONGLEY LN, RENO, NV 89511-3297
(916) 305-6345
Mailing address
5442 LONGLEY LN, RENO, NV 89511-3297
(916) 305-6345
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
Other
Enumeration date
04/01/2024
Last updated
03/18/2025
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