Healthcare Provider Details

I. General information

NPI: 1073565370
Provider Name (Legal Business Name): DR. EWELL BICKHAM III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5266 COMMERCE ST
SAINT FRANCISVILLE LA
70775-4409
US

IV. Provider business mailing address

PO BOX 368
SAINT FRANCISVILLE LA
70775-0368
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-2436
  • Fax: 225-635-2435
Mailing address:
  • Phone: 225-635-3811
  • Fax: 225-635-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number022207
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.022207
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: