Provider Demographics
NPI:1982763785
Name:BICKEL, GREGORY B (PA-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:BICKEL
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 1:3810 KERN WAY STE B
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7805
Mailing Address - Country:US
Mailing Address - Phone:509-228-7237
Mailing Address - Fax:844-315-7388
Practice Address - Street 1:3810 KERN WAY STE B
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7805
Practice Address - Country:US
Practice Address - Phone:509-228-7237
Practice Address - Fax:844-315-7388
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA10003810OtherLICENSE NUMBER
WAS84244Medicare UPIN