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General NPI Number Information
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NPI Number | 1124624234
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Entity Type | Individual
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Provider Name | LEE H BRICKER PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 1 KETTERING WAY STE 200
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City | PIQUA
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State | OH
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Zip | 45356-4109
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Country | US
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Telephone | 937-916-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 152 BLACKSTONE DR
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City | CENTERVILLE
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State | OH
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Zip | 45459-4304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.006571RX
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License Number State | OH
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