Individual
MR. JEREMY BICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
33 W RAHN RD, DAYTON, OH 45429-2219
(937) 433-8990
(937) 433-8691
Mailing address
33 W RAHN RD, DAYTON, OH 45429-2219
(937) 433-8990
(937) 433-8691
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50002487
OH
363AS0400X
Surgical Physician Assistant
50-002487
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0075430
—
OH
01
—
50002487
OHIO LICENSE
OH
Enumeration date
09/15/2006
Last updated
07/30/2018
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