Provider Demographics
NPI:1356333843
Name:BACOT, BRIAN CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CARLOS
Last Name:BACOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11567
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:USVI
Mailing Address - Zip Code:00801
Mailing Address - Country:UM
Mailing Address - Phone:340-779-2663
Mailing Address - Fax:340-779-2443
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:PARAGON MEDICAL BUILDING SUITE 205
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2615
Practice Address - Country:US
Practice Address - Phone:340-779-2663
Practice Address - Fax:340-779-2443
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1389207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1314Medicaid
VI1314Medicaid
VI0026234Medicare PIN
VI480001Medicare PIN