Provider Demographics
NPI:1255370359
Name:BICKFORD, ROGER S (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:S
Last Name:BICKFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3064 BIG BEAR DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7133
Mailing Address - Country:US
Mailing Address - Phone:916-212-0994
Mailing Address - Fax:
Practice Address - Street 1:1550 E COVELL BLVD
Practice Address - Street 2:(INSIDE LONGS DRUGS)
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1352
Practice Address - Country:US
Practice Address - Phone:530-758-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 14899363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP47900Medicare UPIN