Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 04-20908 | KS |
Y | 208600000X | Surgeon | 04-20908 | KS |
NPI | 1003825829 |
---|---|
Provider Name | Thomas E Hicks |
First Address | Emporia, KS 66801-2587 |
Second Address | Emporia, KS 66801-2587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 04/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067092 | MEDICARE PTAN (01) | KS |
100151130B | (05) | KS |
D09146 | (02) |