Healthcare Provider Details

I. General information

NPI: 1295055796
Provider Name (Legal Business Name): JAMES DAVID BACON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF KENTUCKY 800 ROSE STREET
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

800 ROSE ST ANESTHESIOLOGY
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2636
  • Fax:
Mailing address:
  • Phone: 859-218-0069
  • Fax: 859-323-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number50171
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number50171
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: