Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 02959 | KY |
N | 207X00000X | Orthopaedic Surgeon | 240996 | NY |
N | 207X00000X | Orthopaedic Surgeon | 54330 | CT |
N | 207XS0117X | Orthopaedic Spine Surgeon | 02959 | KY |
N | 207XS0117X | Orthopaedic Spine Surgeon | 16410 | NH |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 54330 | CT |
NPI | 1376744565 |
---|---|
Provider Name | Dr. Alfred K Hicks JR. |
First Address | Middletown, CT 06457-4788 |
Second Address | Middletown, CT 06457-4788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 01/07/2015 |