Healthcare Provider Details

I. General information

NPI: 1710919840
Provider Name (Legal Business Name): JAMES R HICKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 N 7TH ST SUITE B104
PHOENIX AZ
85022
US

IV. Provider business mailing address

14001 N 7TH ST SUITE B104
PHOENIX AZ
85022
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-2959
  • Fax: 602-548-5881
Mailing address:
  • Phone: 602-993-2959
  • Fax: 602-548-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13871
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: