NPI 1972530053 · live from the CMS NPI Registry
Mark Robert Bacon, PA-C
Physician Assistant, Medical in Tinker Afb, OK. National Provider Identifier 1972530053, active.
NPI record
| NPI | 1972530053 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Medical 363AM0700X |
| Practice location | 72nd Medical Group, 5700 Arnold St, Tinker Afb, OK 73145 |
| Practice phone | 405-736-4943 |
| Mailing address | 748 Milan Ct, Edmond, OK 73034 |
| Enumerated | June 26, 2006 |
| Last updated | July 8, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant, Medical primary | 363AM0700X | 1389 (OK) |
| Physician Assistant, Medical | 363AM0700X | 602 (AK) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.