MEDICARE: DR. JOHN K BICKERTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME0045749	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00064764	OTHER	FL	MEDICARE RR

General Provider Information

NPI Number	:	1588648067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN K BICKERTON MD

Provider Business Mailing Address
First Line	:	3100 CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7331
Country	:	US
Telephone Number	:	407-380-2216
Fax Number	:	407-380-2710

Provider Business Practice Location Address
First Line	:	3100 CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7331
Country	:	US
Telephone Number	:	407-380-2216
Fax Number	:	407-380-2710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	05/14/2020

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