Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME47745 | FL |
NPI | 1003808098 |
---|---|
Provider Name | Dr. Guy H Hickman |
First Address | Vero Beach, FL 32960-6522 |
Second Address | Vero Beach, FL 32960-6521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 24/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
044017500 | (05) | FL |
31192 | BCBS (01) | FL |
D54254 | (02) | FL |