Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | E-4374 | AR |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 12709 | TN |
N | 2086S0122X | Plastic and Reconstructive Surgery | E-4374 | AR |
NPI | 1033209606 |
---|---|
Provider Name | William Leslie Hickerson |
First Address | Memphis, TN 38103-3409 |
Second Address | Memphis, TN 38103-3409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00154377 | (05) | MS |
003179306A | (05) | GA |
1033209606 | (05) | MO |
111048001 | (05) | AR |
177555 | (05) | AL |
3001590 | (05) | TN |
A96749 | (02) |