Individual
MR. MICAH S. BICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
535 NE 6TH AVE, ESTACADA, OR 97023-9312
(503) 630-8550
Mailing address
4555 N WILLIAMS AVE, PORTLAND, OR 97217-2955
(971) 373-4165
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA
OR
363A00000X
Physician Assistant
0325344
KS
363A00000X
Physician Assistant
Primary
PA175642
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100427720B
—
KS
05
—
1518053511
—
WA
05
—
500710332
—
OR
01
—
R188820
MEDICARE PTAN
OR
Enumeration date
10/05/2006
Last updated
04/06/2020
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