Individual
DR. JEFFREY CARL BICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 799-5335
Mailing address
531 4TH AVE, LEWISTON, ID 83501-2450
(208) 743-4393
(208) 743-4214
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
19210
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010168313
REGENCE BLUE SHIELD OF IDAHO
ID
01
—
0238393
DLI
WA
01
—
77490
BLUE CROSS OF IDAHO
ID
05
—
808115100
—
ID
05
—
8519183
—
WA
Enumeration date
09/01/2006
Last updated
11/05/2008
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