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General NPI Number Information
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NPI Number | 1508086323
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Entity Type | Organization
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Legal Business Name | DAVID R. FICKLEN, M.D., P.A.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 102 MEDICAL PARK LN STE A
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City | HUNTSVILLE
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State | TX
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Zip | 77340-4975
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Country | US
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Telephone | 936-435-0014
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Fax | 936-435-9108
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Provider Business Mailing Address
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Address Line | 102 MEDICAL PARK LN STE A
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City | HUNTSVILLE
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State | TX
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Zip | 77340-4975
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Country | US
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Telephone | 936-435-0014
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Fax | 936-435-9108
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID R FICKLEN
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Credential | M.D.
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Telephone | 936-435-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | K5929
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License Number State | TX
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