Provider Demographics
NPI:1851106447
Name:BACON, ALEX KEITH
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:KEITH
Last Name:BACON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 467 BOX 5194
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096-1052
Mailing Address - Country:US
Mailing Address - Phone:619-333-8368
Mailing Address - Fax:
Practice Address - Street 1:101 SANCTUARY LN
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-5435
Practice Address - Country:US
Practice Address - Phone:205-259-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care