Individual
JOHN ERIC BICKNELL SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7925 YOUREE DRIVE, SUITE 280A, SHREVEPORT, LA 71105
(318) 798-6833
(318) 798-6835
Mailing address
7925 YOUREE DRIVE, SUITE 280A, SHREVEPORT, LA 71105
(318) 798-6833
(318) 798-6835
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
016810
LA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
016810
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1392715
—
LA
05
—
X9X029868
—
TX
Enumeration date
11/29/2006
Last updated
11/13/2012
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