Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PRO000000184 | TN |
NPI | 1174888457 |
---|---|
Provider Name | Mr. Philip Anthony Bickert |
First Address | Corinth, MS 38835-2463 |
Second Address | Corinth, MS 38834-7913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 01/10/2013 |