Provider Demographics
NPI:1285651737
Name:BICKEL, PERRY EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:EARL
Last Name:BICKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-2800
Mailing Address - Fax:214-645-2808
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-2800
Practice Address - Fax:214-645-2808
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000153492207RE0101X
TXM9163207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205087901Medicaid
128146OtherMO-BLUE SHIELD
TX8P5713OtherBCBS
TX193618901Medicaid
TX8K5650Medicare PIN
TX193618901Medicaid