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1487609657

NPI Code Detail

MEDICARE: DR. JOHN BACON MD

MEDICARE: DR. JOHN 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	208000000X	Pediatrics Physician	35.063936	OH

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	:	1487609657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BACON MD

Provider Business Mailing Address
First Line	:	4685 FOREST AVE STE C
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3359
Country	:	US
Telephone Number	:	513-246-7796
Fax Number	:	513-852-8525

Provider Business Practice Location Address
First Line	:	8040 PRINCETON-GLENDALE RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-0000
Country	:	US
Telephone Number	:	513-246-7000
Fax Number	:	513-246-5479

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	10/01/2014

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Directions to “ DR. JOHN BACON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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