Provider Demographics
NPI:1073574364
Name:HICKS, PATRICIA JOAN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOAN
Last Name:HICKS
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 1:2350 N STEMMONS FWY STE 2450
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2700
Mailing Address - Country:US
Mailing Address - Phone:469-488-7200
Mailing Address - Fax:
Practice Address - Street 1:2350 N STEMMONS FWY STE 2450
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2700
Practice Address - Country:US
Practice Address - Phone:469-488-7200
Practice Address - Fax:469-488-7201
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5351208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A99543Medicare UPIN