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General NPI Number Information
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NPI Number | 1609372499
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Entity Type | Individual
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Provider Name | JOHN RHODES WICKMAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 1601 TRINITY ST STOP Z0800
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City | AUSTIN
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State | TX
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Zip | 78712-1765
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Country | US
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Telephone | 512-495-5089
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 TRINITY ST STOP Z0800
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City | AUSTIN
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State | TX
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Zip | 78712-1765
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Country | US
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Telephone | 512-495-5089
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2023009376
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License Number State | MO
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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 | V2329
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License Number State | TX
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