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General NPI Number Information
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NPI Number | 1851603062
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Entity Type | Individual
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Provider Name | MASON H HICKS PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/04/2024
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Provider Practice Location Address
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Address Line | 5147 N 9TH AVE STE 103
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City | PENSACOLA
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State | FL
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Zip | 32504-8770
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Country | US
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Telephone | 850-494-9000
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Fax | 850-416-1912
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Provider Business Mailing Address
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Address Line | 1017 FAIRNIE AVE
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City | PENSACOLA
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State | FL
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Zip | 32503-5313
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Country | US
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Telephone | 843-822-0711
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | MPA1559
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9111053
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License Number State | FL
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