Healthcare Provider Details

I. General information

NPI: 1184713844
Provider Name (Legal Business Name): PATRICK D BACON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/11/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 E FLORIDA AVE
DENVER CO
80210-2571
US

IV. Provider business mailing address

3801 E FLORIDA AVE
DENVER CO
80210-2538
US

V. Phone/Fax

Practice location:
  • Phone: 720-763-9001
  • Fax: 720-763-9785
Mailing address:
  • Phone: 720-863-6012
  • Fax: 720-763-9785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26048
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number26048
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: