| Donna L Bacon Md Pa | |
|
1282 Us Highway 1 Ste 1 Rockledge FL 32955-2747 | |
| (321) 631-3693 | |
| (321) 631-7618 |
| Full Name | Donna L Bacon Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1282 Us Highway 1 Ste 1, Rockledge, Florida |
| Authorized Official Name and Position | Donna L Bacon (PRESIDENT) |
| Authorized Official Contact | 3216313693 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Donna L Bacon Md Pa 1282 Us Highway 1 Ste 1 Rockledge FL 32955-2747 Ph: (321) 631-3693 | Donna L Bacon Md Pa 1282 Us Highway 1 Ste 1 Rockledge FL 32955-2747 Ph: (321) 631-3693 |
| NPI Number | 1306088802 |
|---|---|
| Provider Enumeration Date | 03/30/2009 |
| Last Update Date | 10/31/2023 |
| Medicare PECOS PAC ID | 4082766464 |
|---|---|
| Medicare Enrollment ID | O20090715000661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306088802 | NPI | - | NPPES |
| 101544100 | Medicaid | FL | |
| ME71719 | Other | FL | MEDICAL LIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME71719 (Florida) | Primary |
| Provider Name | Donna L Bacon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215934476 PECOS PAC ID: 1557413937 Enrollment ID: I20090715000650 |
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