Individual
MR. MARK ROBERT BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
72ND MEDICAL GROUP, 5700 ARNOLD ST, TINKER AFB, OK 73145
(405) 736-4943
Mailing address
748 MILAN CT, EDMOND, OK 73034-6897
(405) 330-4946
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1389
OK
363AM0700X
Medical Physician Assistant
602
AK
Other
Enumeration date
06/26/2006
Last updated
07/08/2007
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