Healthcare Provider Details

I. General information

NPI: 1992831861
Provider Name (Legal Business Name): REX G BICKERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 LAFAYETTE PKWY
FLOYDS KNOBS IN
47119-9760
US

IV. Provider business mailing address

3511 LAFAYETTE PKWY
FLOYDS KNOBS IN
47119-9760
US

V. Phone/Fax

Practice location:
  • Phone: 812-981-8081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35-047439
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0498573
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: