MEDICARE: MR. ROBERT J BACON JR. 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	2084P0800X	Psychiatry Physician	F0861	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00117827	OTHER	TX	RR MEDICARE
4	260034924	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700951704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT J BACON JR. MD

Provider Business Mailing Address
First Line	:	1919 NORTH LOOP W STE 224
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1366
Country	:	US
Telephone Number	:	713-655-9410
Fax Number	:	713-869-4506

Provider Business Practice Location Address
First Line	:	1919 NORTH LOOP W STE 224
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1366
Country	:	US
Telephone Number	:	713-655-9410
Fax Number	:	713-869-4506

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	07/08/2020

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