Basic Information
| Provider Information | |||||||||
| NPI: | 1407844715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECHTEL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1241 W STADIUM BLVD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651096023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736352282 | ||||||||
| FaxNumber: | 5736352536 | ||||||||
| Practice Location | |||||||||
| Address1: | 2809 DENNY AVE | ||||||||
| Address2: | |||||||||
| City: | PASCAGOULA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395815301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288095251 | ||||||||
| FaxNumber: | 2288095255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 2003027615 | MO | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 26077 | MS | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 208999201 | 05 | MO | MEDICAID | 214340 | 01 | GHP | OTHER | 33739011 | 01 | BCBS OF KC | OTHER | 3600603 | 01 | UNITED HEALTH CARE | OTHER | H99009 | 01 | MERCY HEALTH PLANS | OTHER | 189992 | 01 | BCBS OF MO | OTHER | 5132415 | 01 | AETNA | OTHER | 65201A005 | 01 | TRICARE | OTHER | 661744 | 01 | HEALTHLINK | OTHER |