MEDICARE: DR. PEARLMAN DAVID HICKS JR. 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
1	2086S0122X	Plastic and Reconstructive Surgery Physician	G39324	CA
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	G39324	CA
3	208200000X	Plastic Surgery Physician	G39324	CA
4	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	G39324	CA
5	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	G39324	CA
6	208600000X	Surgery Physician	G39324	CA
7	2086S0105X	Surgery of the Hand (Surgery) Physician	G39324	CA
8	2086S0127X	Trauma Surgery Physician	G39324	CA
9	2086S0120X	Pediatric Surgery Physician	G39324	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G39324	OTHER	CA	PHYSICIAN LINCES NUMBER

General Provider Information

NPI Number	:	1215966809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEARLMAN DAVID HICKS JR. MD

Provider Business Mailing Address
First Line	:	2360 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-3260
Country	:	US
Telephone Number	:	562-595-9493
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-3260
Country	:	US
Telephone Number	:	562-595-9493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	09/28/2010

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