Provider Demographics
NPI:1174815336
Name:E DARYL BICKFORD MDPA
Entity Type:Organization
Organization Name:E DARYL BICKFORD MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:DARYL
Authorized Official - Last Name:BICKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:367-573-4331
Mailing Address - Street 1:117 MEDICAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3114
Mailing Address - Country:US
Mailing Address - Phone:361-573-4331
Mailing Address - Fax:361-573-5096
Practice Address - Street 1:117 MEDICAL DR STE 1
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3114
Practice Address - Country:US
Practice Address - Phone:361-573-4331
Practice Address - Fax:361-573-5096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283102601Medicaid
TX283102601Medicaid