Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 35-05-0204-B | OH |
Y | 207RI0011X | Interventional Cardiology | 35.050204 | OH |
NPI | 1063413474 |
---|---|
Provider Name | James P. Bacon |
First Address | Dublin, OH 43017-0727 |
Second Address | Mansfield, OH 44903-2269 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 21/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0687092 | (05) | OH |
A17396 | (02) | OH |