MEDICARE: PATRICK D BACON 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	26048	CO
2	2084P0804X	Child & Adolescent Psychiatry Physician	26048	CO

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

General Provider Information

NPI Number	:	1184713844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK D BACON MD

Provider Business Mailing Address
First Line	:	3801 E FLORIDA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-2538
Country	:	US
Telephone Number	:	720-863-6012
Fax Number	:	720-763-9785

Provider Business Practice Location Address
First Line	:	3801 E FLORIDA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-2571
Country	:	US
Telephone Number	:	720-763-9001
Fax Number	:	720-763-9785

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/11/2021

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