Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 35-08-5868 | OH |
N | 208600000X | Surgeon | 35-08-5868 | OH |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 35.085868 | OH |
NPI | 1326054073 |
---|---|
Provider Name | Todd L Hicks |
First Address | Centerville, OH 45459-1294 |
Second Address | Dayton, OH 45429-3474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 04/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2665174 | (05) | OH |