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General NPI Number Information
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NPI Number | 1356376289
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Entity Type | Individual
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Provider Name | DERRICK GERARD HICKEY MD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 206 CAUSEWAY DR UNIT 232
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City | WRIGHTSVILLE BEACH
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State | NC
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Zip | 28480-1759
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Country | US
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Telephone | 910-791-4492
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 OLD BRANCH RD C/O D. HICKEY, PRESIDENT, PORT CITY ORTHOPAEDICS PLLC
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City | WILMINGTON
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State | NC
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Zip | 28409
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Country | US
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Telephone | 910-791-4492
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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 | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 200201100
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 200201100
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License Number State | NC
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