Provider Demographics
NPI:1013962810
Name:BACON, STACY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ANNE
Last Name:BACON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3840
Mailing Address - Country:US
Mailing Address - Phone:281-664-2107
Mailing Address - Fax:281-955-5875
Practice Address - Street 1:21212 NORTHWEST FWY STE 605
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5889
Practice Address - Country:US
Practice Address - Phone:281-955-7577
Practice Address - Fax:281-955-5875
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0651207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4308OtherBC/BS PIN
TX8G5979Medicare PIN