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General NPI Number Information
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NPI Number | 1225492531
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Entity Type | Individual
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Provider Name | STEPHEN BRADLEY HICKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 3344 N FUTRALL DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-582-7230
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Fax | 479-582-7329
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Provider Business Mailing Address
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Address Line | P.O. BOX 550
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City | LOWELL
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State | AR
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Zip | 72745
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Country | US
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Telephone | 479-463-7775
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Fax | 479-463-7187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 62539
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | E-15542
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License Number State | AR
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