MR. MARK ROBERT BACON (NPI# 1972530053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972530053 |
| Entity Type | Individual |
| Full Name | MR. MARK ROBERT BACON |
| Credential | PA-C |
| Practice Address |
72nd Medical Group 5700 Arnold St Tinker Afb OK 73145 |
| Mailing Address |
748 Milan Ct Edmond OK 73034-6897 |
| Practice Telephone | 4057364943 |
| Mailing Telephone | 4053304946 |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
602 | AK | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
1389 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
72ND MEDICAL GROUP 5700 ARNOLD ST |
| City | TINKER AFB |
| State | OK |
| Zip Code | 73145 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922630946 | The Janz Corporation | Durable Medical Equipment & Medical Supplies | Tinker Afb Exchange, 3360 N. Avenue Bldg. 685, Tinker Afb, OK 73145 | 2020-02-07 |
| 1578863437 | Stephanie Brushett | Audiologist | 8941 Entrance Road A, Bldg 3334, Rm 125, Tinker Afb, OK 73145 | 2010-10-26 |
| 1417945346 | Heather Renee' Ranger Kobel | Psychologist | 590 Mitchell Blvd, Tinker Afb, OK 73145 | 2005-10-13 |
| 1003332404 | Davis Brigman | Psychologist | 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 | 2017-08-17 |
| 1801321393 | Carolyne Bangurah | Registered Nurse | 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 | 2017-04-21 |
| 1598148850 | Adrianna Harrell | Social Worker | 7050 Air Depot Blvd, Tinker Afb, OK 73145 | 2015-07-06 |
| 1558748491 | Caitlin Clare Stevens | General Practice | 7050 Air Depot Blvd Bldg 1094, Tinker Afb, OK 73145 | 2015-04-29 |
| 1699015032 | Alan Robert Miner | General Practice | 7050 Air Depot Blvd, Oklahoma City, OK 73145 | 2013-02-21 |
| 1033498571 | Sarah Katherine Turbush | Dentist | 72d Medical Group, Tinker Afb, OK 73145 | 2011-08-16 |
| 1659682805 | Nikki Louise Mochko | Dentist | 7050 Air Depot Blvd, Tinker Afb, OK 73145 | 2010-06-22 |
| Find all providers in zip 73145 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972923605 | Matthew Gray | Physician Assistant | 7050 Air Depot Blvd Bldg 1094, 72mdg, Tinker Afb, OK 73145-8716 | 2014-04-21 |
| 1326479619 | Nathan Hamilton | Physician Assistant | 7050 Air Depot Blvd, Sgof, Tinker Afb, OK 73145-8716 | 2013-12-11 |
| 1407002520 | Caitlin Elizabeth Michael | Physician Assistant | 5700 Arnold St, 72mdg/sgol, Tinker Afb, OK 73145-8105 | 2008-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790392868 | James Scott Turner | Physician Assistant | 924 Nw 14th St, Moore, OK 73160-1610 | 2020-09-23 |
| 1386283679 | Cody Rice Chambers | Physician Assistant | 2002 12th Ave Nw Ste B, Ardmore, OK 73401-1206 | 2020-01-03 |
| 1073154647 | Haley Nicole Beaird | Physician Assistant | 8907 E 93rd St, Tulsa, OK 74133-5634 | 2019-10-03 |
| 1568920924 | Direct2u Urgent Care Pllc | Physician Assistant | 2417 County Road 1263, Blanchard, OK 73010-3123 | 2019-03-05 |
| 1538625660 | Symachia LLC | Physician Assistant | 115 N. Main St., Cashion, OK 73106 | 2019-02-13 |
| 1982172029 | William Landon Ross | Physician Assistant | 3705 W Memorial Rd Ste 101, Oklahoma City, OK 73134-1508 | 2018-11-07 |
| 1639646656 | Jacob Allbritton | Physician Assistant | 10824 Admiral Dr, Oklahoma City, OK 73162-6843 | 2018-10-29 |
| 1316420086 | Lauren Anto | Physician Assistant | 2824 Classen Blvd Ste 100, Norman, OK 73071-4059 | 2018-09-10 |
| 1073004768 | Shelby Teel | Physician Assistant | 1200 Everett Dr # 8305, Oklahoma City, OK 73104-5047 | 2018-05-29 |
| 1093240749 | Green's Country Clinic, LLC | Physician Assistant | 223 E Blackwell Ave, Blackwell, OK 74631-2909 | 2017-05-01 |
| Find all providers with the same taxonomy | ||||
| City | TINKER AFB |
| Zip Code | 73145 |
Please comment or provide details below to improve the information on MR. MARK ROBERT BACON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.