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General NPI Number Information
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NPI Number | 1972502284
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Entity Type | Individual
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Provider Name | DONALD DAVID BACON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1202 E SONTERRA BLVD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4238
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Country | US
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Telephone | 210-546-1410
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Fax | 210-546-1419
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Provider Business Mailing Address
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Address Line | 1202 E SONTERRA BLVD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3944
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Country | US
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Telephone | 210-546-1410
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Fax | 210-546-1419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | E2452
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License Number State | TX
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