Basic Information
| Provider Information | |||||||||
| NPI: | 1700982980 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES R HICKS, MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 W GLENDALE AVE | ||||||||
| Address2: | E119 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850518194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239150270 | ||||||||
| FaxNumber: | 6239150280 | ||||||||
| Practice Location | |||||||||
| Address1: | 14001 N 7TH ST | ||||||||
| Address2: | B104 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850224382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022126774 | ||||||||
| FaxNumber: | 6025485881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 02/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6239150294 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.