Healthcare Provider Details

I. General information

NPI: 1700982980
Provider Name (Legal Business Name): JAMES R HICKS, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 N 7TH ST B104
PHOENIX AZ
85022-4382
US

IV. Provider business mailing address

4225 W GLENDALE AVE E119
PHOENIX AZ
85051-8194
US

V. Phone/Fax

Practice location:
  • Phone: 602-212-6774
  • Fax: 602-548-5881
Mailing address:
  • Phone: 623-915-0270
  • Fax: 623-915-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES R HICKS
Title or Position: PRESIDENT
Credential: MD
Phone: 623-915-0294