Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | C10009160 | DE |
N | 2086S0120X | Pediatric Surgery | MA08651400 | NJ |
N | 2086S0120X | Pediatric Surgery | MD437936 | PA |
NPI | 1174588990 |
---|---|
Provider Name | Dr. Barry A Hicks |
First Address | Dallas, TX 75235 |
Second Address | Dallas, TX 75235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 21/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0208949 | (05) | NJ |
044149501 | (05) | TX |
102421891 | (05) | PA |
418355 | (05) | MD |
D93209 | (02) |