MEDICARE: STEPHEN T. HICKEY, M.D., P.A.

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	2084N0400X	Neurology Physician	ME0055724	FL

General Provider Information

NPI Number	:	1801076112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN T. HICKEY, M.D., P.A.

Provider Business Mailing Address
First Line	:	335 11TH AVE N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-7251
Country	:	US
Telephone Number	:	904-242-0422
Fax Number	:	904-242-0241

Provider Business Practice Location Address
First Line	:	335 11TH AVE N
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-7251
Country	:	US
Telephone Number	:	904-242-0422
Fax Number	:	904-242-0241

Authorized Official
Title or Position	:	DOCTOR'S WIFE
Name	:	MRS. CARRIE HICKEY
Credential	:	R.N.
Telephone Number	:	904-242-0422

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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