Provider Demographics
NPI:1982688172
Name:BACON, ARTHUR J (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:J
Last Name:BACON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3296
Mailing Address - Fax:702-804-3655
Practice Address - Street 1:6365 E TANQUE VERDE RD #120
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3848
Practice Address - Country:US
Practice Address - Phone:520-290-0300
Practice Address - Fax:520-298-9230
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2017-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ27256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
860780125OtherCIGNA
2Z2146OtherHEALTHNET
103760OtherPACIFICARE SECURE HORIZON
AZ0775800OtherBLUE CROSS BLUE SHIELD
2084836OtherUNITED HEALTHCARE
P00240773OtherRR MEDICARE
AZ0775800OtherBLUE CROSS BLUE SHIELD
2084836OtherUNITED HEALTHCARE
AZZ188906Medicare PIN