Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | E2614 | TX |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | E2614 | TX |
NPI | 1801863840 |
---|---|
Provider Name | James M. Hicks |
First Address | Austin, TX 78758-2483 |
Second Address | Austin, TX 78758-2483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 30/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120118801 | (05) | TX |
D66567 | (02) | TX |