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General NPI Number Information
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NPI Number | 1396819462
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Entity Type | Organization
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Legal Business Name | GREGORY D HICKS M.D. P.A-PLASTIC & RECONSRUCTIVE SURGERY
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 3801 BEE RIDGE ROAD SUITE 1
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City | SARASOTA
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State | FL
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Zip | 34233
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Country | US
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Telephone | 941-925-3633
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Fax | 941-925-1435
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Provider Business Mailing Address
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Address Line | 3801 BEE RIDGE ROAD SUITE 1
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City | SARASOTA
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State | FL
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Zip | 34233
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Country | US
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Telephone | 941-925-3633
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Fax | 941-925-1435
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GREGORY D HIELES
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Credential | MD
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Telephone | 941-925-3633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME42730
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License Number State | FL
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