Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | D0028727 | MD |
NPI | 1538162078 |
---|---|
Provider Name | John Richard Bacon |
First Address | Towson, MD 21204-7525 |
Second Address | Towson, MD 21204-7525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2005 |
Last Update Date | 19/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26692-1800 | (05) | MD |
B66916 | (02) | MD |