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NPI Code Detail

MEDICARE: JOHNNY RAY BIDDLE JR. M.D.

MEDICARE: JOHNNY RAY BIDDLE JR. M.D.
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
1174400000XSpecialist05629RLA
2207Q00000XFamily Medicine Physician05629RLA
3208D00000XGeneral Practice Physician05629RLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902010952
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNY RAY BIDDLE JR. M.D.
Provider Business Mailing Address
First Line : 630 W PRIEN LAKE RD
Second Line : B 210
City : LAKE CHARLES
State : LA
Zip : 70601-0700
Country : US
Telephone Number : 337-936-6893
Fax Number : 337-564-0931
Provider Business Practice Location Address
First Line : 3608 KIRKMAN ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70607-3006
Country : US
Telephone Number : 337-936-6893
Fax Number : 337-564-0931
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 11/10/2015

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