Individual provider · NPI-1

Nickolas Bacon, MD

Internal Medicine · Festus, MO

NPI number1972172666
StatusActive
Last updated in NPPESAug 5, 2024

Details

NPI
1972172666
Entity type
Individual (NPI-1)
Name
Nickolas Bacon
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Jun 17, 2021
Certification date
Aug 5, 2024
Last updated
Aug 5, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine2024001495MOYes

Practice location

1400 Us Highway 61
Festus, MO 63028-4100

Phone 636-933-5337

Mailing address

1400 Us Highway 61 Ste H1521
Festus, MO 63028-4100

Phone 636-933-5337

Other practice locations

10010 Kennerly Rd
Saint Louis, MO 63128-2106

Phone 314-525-1328

615 S New Ballas Rd
Saint Louis, MO 63141-8221

Phone 314-251-6339

901 E 5th St
Washington, MO 63090-3127

Phone 636-239-8231

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