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General NPI Number Information
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NPI Number | 1336422385
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Entity Type | Individual
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Provider Name | DANIEL E HICKS PA
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Gender | Male
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 12412 JUDSON RD
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City | LIVE OAK
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State | TX
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Zip | 78233-3255
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Country | US
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Telephone | 210-757-5034
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Fax | 210-510-7260
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Provider Business Mailing Address
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Address Line | 1023 MORNING GLN
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City | SPRING BRANCH
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State | TX
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Zip | 78070-4955
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Country | US
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Telephone | 801-870-8921
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA21937
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA12808
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License Number State | TX
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