Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2017018407 | MO |
N | 111NI0900X | Internist | 2017018407 | MO |
Y | 207RC0000X | Internist - Cardiovascular Disease | 2020019589 | MO |
NPI | 1013446285 |
---|---|
Provider Name | Trenton Bickel |
First Address | Columbia, MO 65212-1000 |
Second Address | Columbia, MO 65212-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2017 |
Last Update Date | 01/07/2020 |