Basic Information
| Provider Information | |||||||||
| NPI: | 1356333843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACOT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | CARLOS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11567 | ||||||||
| Address2: | |||||||||
| City: | ST THOMAS | ||||||||
| State: | USVI | ||||||||
| PostalCode: | 00801 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 3407792663 | ||||||||
| FaxNumber: | 3407792443 | ||||||||
| Practice Location | |||||||||
| Address1: | 9149 ESTATE THOMAS | ||||||||
| Address2: | PARAGON MEDICAL BUILDING SUITE 205 | ||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008022615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407792663 | ||||||||
| FaxNumber: | 3407792443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 04/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 1389 | VI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1314 | 05 | VI | MEDICAID |