Provider Demographics
NPI:1033478532
Name:HICKMAN, ERIN (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 NW 167TH PL STE 103
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4805
Mailing Address - Country:US
Mailing Address - Phone:503-672-6050
Mailing Address - Fax:503-672-6051
Practice Address - Street 1:1960 NW 167TH PL STE 103
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4805
Practice Address - Country:US
Practice Address - Phone:503-672-6050
Practice Address - Fax:503-672-6051
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD172263208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice