MEDICARE: DONNA M. HICKOX 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	2083X0100X	Occupational Medicine Physician	G49943	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770669293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M. HICKOX MD

Provider Business Mailing Address
First Line	:	275 HOSPITAL PKWY
Second Line	:	SUITE 565
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1106
Country	:	US
Telephone Number	:	408-972-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 HOSPITAL PKWY
Second Line	:	SUITE 565
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1106
Country	:	US
Telephone Number	:	408-972-6800
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	08/16/2007

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