Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD172263 | OR |
NPI | 1033478532 |
---|---|
Provider Name | Erin Hickman |
First Address | Beaverton, OR 97006-4805 |
Second Address | Beaverton, OR 97006-4805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2012 |
Last Update Date | 05/10/2015 |