DR. JOSHUA BENJAMIN BACON (NPI# 1396274551) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396274551 |
| Entity Type | Individual |
| Full Name | DR. JOSHUA BENJAMIN BACON |
| Credential | MD |
| Practice Address |
4345 Nelson Rd Lake Charles LA 70605-4156 |
| Mailing Address |
Po Box 123594 Dept 3594 Dallas TX 75312-0001 |
| Practice Telephone | 3374807900 |
| Practice Fax Number | 3374807901 |
| Mailing Telephone | 3374942772 |
| Mailing Fax Number | 3374942928 |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2020-07-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 323354 | LA | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 2017016687 | MO | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Hospital Dr., Ma303, Dc032.00, Columbia, MO 65212 | 5736425911 | 5736423015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487023685 | Joshua Bacon | Psychologist | 240 E 38th St Fl 18, New York, NY 10016-2708 | 2015-09-17 |
| 1013224237 | Joshua Bacon | Pharmacist | Highway 666 North, Medical Center Complex, Shiprock, NM 87420 | 2010-09-09 |
| 1265796163 | Joshua William Bacon | Case Manager/Care Coordinator | 201 W Springdale Ave, Knoxville, TN 37917-5158 | 2012-06-26 |
| Street Address |
4345 NELSON RD |
| City | LAKE CHARLES |
| State | LA |
| Zip Code | 70605-4156 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841492196 | Seth Thomas Billiodeaux | Anesthesiology | 4345 Nelson Rd, Lake Charles, LA 70605-4156 | 2007-05-31 |
| 1558838615 | Christian Michael Bertrand | Nurse Practitioner | 4345 Nelson Rd, Lake Charles, LA 70605-4156 | 2018-10-26 |
| 1588165617 | Seth Billiodeaux Md LLC | Anesthesiology | 4345 Nelson Rd, Lake Charles, LA 70605-4156 | 2018-02-23 |
| 1295103844 | Mmg Nelson Rd LLC | Psychiatry & Neurology | 4345 Nelson Rd, Lake Charles, LA 70605-4156 | 2015-09-11 |
| 1437546595 | Robert Joseph Vangossen Jr. | Family Medicine | 4345 Nelson Rd, Lake Charles, LA 70605-4156 | 2015-04-16 |
| 1932543915 | Kenneth W. Leger | Pediatrics | 4345 Nelson Rd, Lake Charles, LA 70605-4156 | 2013-04-22 |
| 1538434733 | Robert Dale Bernauer Jr. | Emergency Medicine | 4345 Nelson Rd, Lake Charles, LA 70605 | 2012-03-21 |
| 1225234701 | Holley Nanette Kelley | Family Medicine | 4345 Nelson Rd, Lake Charles, LA 70605-4119 | 2007-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780283606 | Kristin R Morris | Clinical Nurse Specialist | 1900 W. Gaythier Rd, Lake Charles, LA 70605 | 2020-10-21 |
| 1548871577 | Jacob M Theriot | Nurse Practitioner | 2640 County Club Rd., Lake Charles, LA 70605 | 2020-08-13 |
| 1053898403 | Heather Spallino Duplechain | Nurse Practitioner | 6713 Nelson Rd., Lake Charles, LA 70605 | 2018-07-27 |
| 1578057956 | Noor Deeb Weckerly | Nurse Practitioner | 6713 Nelson Rd, Lake Charles, LA 70605 | 2018-06-19 |
| 1861993354 | Therapy Works of Swla LLC | Physical Therapist | 4750 Lake Street, Lake Charles, LA 70605 | 2018-02-21 |
| 1669998852 | Amd Healthcare Lc, LLC | General Acute Care Hospital | 3730 Nelson Road, Lake Charles, LA 70605 | 2017-08-18 |
| 1619422474 | Kaitlyn Pinkerton | Specialist/Technologist | 800 E Mcneese St, Lake Charles, LA 70605 | 2016-08-22 |
| 1104274679 | Kelly Rogers | Counselor | 90 N. Luke 102l, Lafayette, LA 70605 | 2016-05-25 |
| 1548616220 | Lisa Monticello Snider | Neurological Surgery | 3297 Portrush Drive, Lake Charles, LA 70605 | 2016-05-11 |
| 1114387404 | Louisiana Dental Professionals, Donovan Dronet, Dds, A Professional De | Dentist | 4459 Nelson Rd, Suite 120, Lake Charles, LA 70605 | 2016-02-29 |
| Find all providers in zip 70605 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982126520 | Executive Medical Clinic of Lake Charles | Family Medicine | 2002 W Walnut St Ste 1a, Lake Charles, LA 70601-5690 | 2017-07-14 |
| 1295184786 | Trina Health of Lake Charles, LLC | Family Medicine | 1714 Wolf Circle, Lake Charles, LA 70605-4050 | 2016-06-06 |
| 1740600683 | Jason Burklow | Family Medicine | 4150 Nelson Rd Ste 3, Lake Charles, LA 70605-4148 | 2014-04-18 |
| 1174871123 | Imperial Health LLP | Family Medicine | 1920 W Sale Rd Bldg F, Lake Charles, LA 70605-2400 | 2012-08-23 |
| 1790033744 | Imperial Health LLP | Family Medicine | 277 N Highway 171 Ste 8, Lake Charles, LA 70611-5374 | 2012-08-23 |
| 1194081414 | Clint Nickolas Lincoln | Family Medicine | 10071 Gulf Hwy, Lake Charles, LA 70607 | 2012-04-11 |
| 1972873610 | Terry Welke | Family Medicine | 707 E Prien Lake Rd Ste B, Lake Charles, LA 70601-8788 | 2012-01-11 |
| 1982839445 | Star Care Service Inc | Family Medicine | 313 Alamo St, Suite B, Lake Charles, LA 70601-8528 | 2009-05-27 |
| 1982862736 | Kamran Mohammad Chaudary | Family Medicine | 4918 E Westridge Park Dr, Lake Charles, LA 70605-6762 | 2008-05-29 |
| 1821255852 | Penny Lynn Goodwin | Family Medicine | 237 Sam Houston Jones Pkwy, Lake Charles, LA 70611-5603 | 2008-05-19 |
| Find all providers in LAKE CHARLES | ||||
| City | LAKE CHARLES |
| Zip Code | 70605 |
Please comment or provide details below to improve the information on DR. JOSHUA BENJAMIN 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.