Provider Demographics
NPI:1407844715
Name:BECHTEL, JOHN H (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:BECHTEL
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 1:1241 W STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6023
Mailing Address - Country:US
Mailing Address - Phone:573-635-2282
Mailing Address - Fax:573-635-2536
Practice Address - Street 1:2809 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5301
Practice Address - Country:US
Practice Address - Phone:228-809-5251
Practice Address - Fax:228-809-5255
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030276152085R0001X
MS260772085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208999201Medicaid
214340OtherGHP
33739011OtherBCBS OF KC
3600603OtherUNITED HEALTH CARE
H99009OtherMERCY HEALTH PLANS
189992OtherBCBS OF MO
5132415OtherAETNA
65201A005OtherTRICARE
661744OtherHEALTHLINK
189992OtherBCBS OF MO
65201A005OtherTRICARE
214340OtherGHP
H99009Medicare UPIN
MO909050635Medicare PIN
MO909052700Medicare PIN
H99009OtherMERCY HEALTH PLANS
MO150630008Medicare PIN