Provider Demographics
NPI:1649212051
Name:BICHON, BARRY KEITH (DO)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:KEITH
Last Name:BICHON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 HANCOCK ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6346
Mailing Address - Country:US
Mailing Address - Phone:615-230-3045
Mailing Address - Fax:615-230-3047
Practice Address - Street 1:179 HANCOCK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6346
Practice Address - Country:US
Practice Address - Phone:615-230-3045
Practice Address - Fax:615-230-3047
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO 0000000395208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4111675OtherBC/BS
C67656Medicare UPIN