| Doctor Name: | JOHNNY RAY BIDDLE |
| NPI Number: | 1902010952 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 05629R |
| Business Practice Address: | 3608 Kirkman St Lake Charles, LA - 706073006 |
| Business Phone Number: | 3379366893 |
| Business Fax Number: | 3375640931 |
| Mailing Address: | 630 W Prien Lake Rd, B 210 LAKE CHARLES |
| State: | LA |
| Postal Code: | 706010700 |
| Phone Number: | 3379366893 |
| Fax Number: | 3375640931 |
| NPI Enumeration Date: | 05/09/2007 |
| NPI Last Update Date: | 11/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 05629R |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | LA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |