MEDICARE: JONATHAN KEEGAN BAKOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	61166	SC

General Provider Information

NPI Number	:	1609361278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN KEEGAN BAKOS MD

Provider Business Mailing Address
First Line	:	100 BUCKWALTER PLACE BLVD STE 130
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-5023
Country	:	US
Telephone Number	:	843-836-7120
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 BUCKWALTER PLACE BLVD STE 130
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-5023
Country	:	US
Telephone Number	:	843-836-7120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	05/21/2024

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