Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 4931 | SD |
NPI | 1659377513 |
---|---|
Provider Name | David Craven Hickey |
First Address | Mckinney, TX 75070-2901 |
Second Address | Mckinney, TX 75070-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6620052 | (05) | SD |
E04433 | (02) |