Individual
CARL WILLIAM BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
181471-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-00096
UTAH HEALTHCARE
UT
01
—
107007443103
IHC
UT
01
—
20045128
PALMETTO
UT
01
—
68078
PEHP
UT
01
—
870281028BAC
EMIA
UT
Enumeration date
09/07/2006
Last updated
11/27/2023
Update your record
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