Bruce Cleaveland Bacon, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME20101 Issued in FL

Practice address

6932 Old Whiskey Creek Dr
Fort Myers, FL 33919-1827

Phone

(239) 939-7609

Fax

(239) 939-7698

NPI assigned

May 23, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kevin M. Strathy, M.D., PA

  • Plastic and Reconstructive Surgery Physician
  • Sebring, FL
  • NPI 1497835045
  NPD (past)
• Surgical Specialists of Southwest Florida P.a.

  • Vascular Surgery Physician
  • Fort Myers, FL
  • NPI 1033103437
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740490002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6932 OLD WHISKEY CREEK DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339191827",
            "telephone_number": "239-939-7609",
            "fax_number": "239-939-7698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6932 OLD WHISKEY CREEK DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339191827",
            "telephone_number": "239-939-7609",
            "fax_number": "239-939-7698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "BRUCE",
        "middle_name": "CLEAVELAND",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME20101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lijy Babu, CRNA
• Back in Motion Specialty Practice LLC
• Back in Motion Sport & Spine Physical Therapy LLC
• Back Pain Institute of Ft. Myers, Inc.
• Leona Backus
• Anais Aurora Badia, DO MD
• Karissa Janisse Badillo Storer, DPM
• Mitko Mitov Badov, M.D.
• Ernesto Jose Badui Cantisano, M.D.
• Lorna Baer, FNP

• Surgery Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.