Provider Demographics
NPI:1831718568
Name:BACON, LUKE PORTER (MD)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:PORTER
Last Name:BACON
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 1:1081 COLUMBINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:804-999-0396
Practice Address - Street 1:1525 RALEIGH ST STE 500
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1594
Practice Address - Country:US
Practice Address - Phone:210-621-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00705742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry