Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 21719-020 | WI |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 21719-020 | WI |
N | 207XS0106X | Orthopaedic Hand Surgeon | 21719-020 | WI |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 21719-020 | WI |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 21719-020 | WI |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 21719-020 | WI |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 21719-020 | WI |
NPI | 1538190483 |
---|---|
Provider Name | Edgar O Hicks |
First Address | Eau Claire, WI 54702-1510 |
Second Address | Eau Claire, WI 54703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B53600 | (02) | WI |