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NPI Code Detail

MEDICARE: DR. RUSSELL D HICKS MD

MEDICARE: DR. RUSSELL D HICKS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianMD60336308WA

General Provider Information

NPI Number : 1215905302
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSELL D HICKS MD
Provider Business Mailing Address
First Line : P.O. BOX 5299
Second Line : MS: 1313-5-PCO
City : TACOMA
State : WA
Zip : 98415-0299
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9330 59TH AVE SW
Second Line : - MULTICARE BEHAVIORAL HEALTH
City : LAKEWOOD
State : WA
Zip : 98499-2858
Country : US
Telephone Number : 253-445-8120
Fax Number : 253-697-8590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 02/23/2022

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