Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | D74400 | MD |
N | 111NI0900X | Internist | D74400 | MD |
N | 207R00000X | Internist | MT191079 | PA |
N | 111NI0900X | Internist | MT191079 | PA |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | D74400 | MD |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | Q7557 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | D74400 | MD |
NPI | 1386808012 |
---|---|
Provider Name | Albert James Hicks III |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508-1590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 28/12/2021 |