Provider Demographics
NPI:1184713844
Name:BACON, PATRICK D (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:D
Last Name:BACON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2538
Mailing Address - Country:US
Mailing Address - Phone:720-863-6012
Mailing Address - Fax:720-763-9785
Practice Address - Street 1:3801 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2571
Practice Address - Country:US
Practice Address - Phone:720-763-9001
Practice Address - Fax:720-763-9785
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO260482084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19724268Medicaid
CO19724268Medicaid
CO5181Medicare ID - Type Unspecified