Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC9941TX | TX |
NPI | 1972513174 |
---|---|
Provider Name | Dr. Jeffrey Lee Hicken |
First Address | Frisco, TX 75034 |
Second Address | Carrollton, TX 75006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 17/08/2015 |