MEDICARE: DR. GILBERT ALAN HICE DPM MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	DP00121	OR

General Provider Information

NPI Number	:	1306093265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILBERT ALAN HICE DPM MS

Provider Business Mailing Address
First Line	:	PO BOX 775
Second Line	:
City	:	GOLD HILL
State	:	OR
Zip	:	97525
Country	:	US
Telephone Number	:	541-582-3880
Fax Number	:	541-582-3880

Provider Business Practice Location Address
First Line	:	953 FOOTS CREEK ROAD
Second Line	:
City	:	GOLD HILL
State	:	OR
Zip	:	97525
Country	:	US
Telephone Number	:	541-582-3880
Fax Number	:	541-582-3880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	08/22/2008

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