Healthcare Provider Details

I. General information

NPI: 1013990878
Provider Name (Legal Business Name): DAVID R. HICKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6585 S YALE AVE STE 200
TULSA OK
74136-8315
US

IV. Provider business mailing address

6585 S YALE AVE STE 200
TULSA OK
74136-8315
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-2767
  • Fax: 918-494-9277
Mailing address:
  • Phone: 918-481-2767
  • Fax: 918-494-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number14047
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number14047
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: