Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 14047 | OK |
N | 207XS0117X | Orthopaedic Spine Surgeon | 14047 | OK |
NPI | 1013990878 |
---|---|
Provider Name | David R. Hicks |
First Address | Tulsa, OK 74136-8315 |
Second Address | Tulsa, OK 74136-8315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2005 |
Last Update Date | 01/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100100290A | (05) | OK |
D39196 | (02) |