Healthcare Provider Details

I. General information

NPI: 1396799698
Provider Name (Legal Business Name): DOUGLAS JAMES HICKOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6653 MAIN ST
WILLIAMSVILLE NY
14221-5906
US

IV. Provider business mailing address

6653 MAIN ST
WILLIAMSVILLE NY
14221-5906
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-4500
  • Fax: 716-204-4501
Mailing address:
  • Phone: 716-204-4500
  • Fax: 716-204-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number204790
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number204790-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: