Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07001040A | IN |
Y | 222Z00000X | Podiatrist | 07001040A | IN |
N | 213ES0103X | Foot & Ankle Surgery | 07001040A | IN |
NPI | 1093709750 |
---|---|
Provider Name | Jason R Bickel |
First Address | Vincennes, IN 47591-0943 |
Second Address | Vincennes, IN 47591-1228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 05/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000542568 | ANTHEM (01) | IN |
000000542574 | ANTHEM (01) | IL |
200879590A | (05) | IN |
V00625 | (02) | TN |