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General NPI Number Information
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NPI Number | 1275517476
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Entity Type | Individual
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Provider Name | BENNETT W BICKNELL MD
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 1265 UNION AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-3415
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Country | US
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Telephone | 316-685-6091
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Fax |
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Provider Business Mailing Address
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Address Line | 6060 PRIMACY PKWY SUITE 241
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City | MEMPHIS
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State | TN
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Zip | 38119-5745
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Country | US
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Telephone | 901-725-5846
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 22953
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 24729
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License Number State | TN
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