Provider Demographics
NPI:1588648067
Name:BICKERTON, JOHN K (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:BICKERTON
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 1:3100 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7331
Mailing Address - Country:US
Mailing Address - Phone:407-380-2216
Mailing Address - Fax:407-380-2710
Practice Address - Street 1:3100 CONWAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7331
Practice Address - Country:US
Practice Address - Phone:407-380-2216
Practice Address - Fax:407-380-2710
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00064764OtherMEDICARE RR
FLD55147Medicare UPIN
FL47700WMedicare PIN
47700SMedicare PIN