Healthcare Provider Details

I. General information

NPI: 1548485816
Provider Name (Legal Business Name): JEFFREY KYLE BACON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8329 BRIMHALL RD SUITE 801
BAKERSFIELD CA
93312-2243
US

IV. Provider business mailing address

8329 BRIMHALL RD SUITE 801
BAKERSFIELD CA
93312-2243
US

V. Phone/Fax

Practice location:
  • Phone: 661-695-8385
  • Fax: 661-679-6801
Mailing address:
  • Phone: 661-695-8385
  • Fax: 661-679-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A11715
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A11715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: