Healthcare Provider Details

I. General information

NPI: 1033131503
Provider Name (Legal Business Name): JOHN R BIES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8002
US

IV. Provider business mailing address

1120 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8002
US

V. Phone/Fax

Practice location:
  • Phone: 812-479-9500
  • Fax: 812-437-0037
Mailing address:
  • Phone: 812-479-9500
  • Fax: 812-437-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number01028928
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01028928A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: