1821086752 NPI number — DR. BRYAN C HICKS MD

Table of content: DR. BRYAN C HICKS MD (NPI 1821086752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821086752 NPI number — DR. BRYAN C HICKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
BRYAN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821086752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5349 SW COLLEGE RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34474-5717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-368-5858
Provider Business Mailing Address Fax Number:
352-368-2044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5349 SW COLLEGE RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-5717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-368-5858
Provider Business Practice Location Address Fax Number:
352-368-2044
Provider Enumeration Date:
10/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  ME47583 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207N00000X , with the licence number: ME47583 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207NS0135X , with the licence number: ME47583 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207NI0002X , with the licence number: ME47586 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207ND0900X , with the licence number: ME47583 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)