Mark L Bickley, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01878 Issued in IA

Practice address

2710 Saint Francis Dr
Suite 210
Waterloo, IA 50702-5619

Phone

(319) 272-5000

Fax

(319) 272-5282

NPI assigned

Jun 9, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1912948126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 KIMBALL AVE",
            "address_2": "LL14",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025063",
            "telephone_number": "319-272-1590",
            "fax_number": "319-272-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 SAINT FRANCIS DR",
            "address_2": "SUITE 210",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025619",
            "telephone_number": "319-272-5000",
            "fax_number": "319-272-5282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BICKLEY",
        "first_name": "MARK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "01878",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2195693",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.