Provider Demographics
NPI:1093904815
Name:HICKS, DAVID L (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:HICKS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3165 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2032
Mailing Address - Country:US
Mailing Address - Phone:727-787-3911
Mailing Address - Fax:727-786-2272
Practice Address - Street 1:3165 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE H
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2032
Practice Address - Country:US
Practice Address - Phone:727-787-3911
Practice Address - Fax:727-786-2272
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS4796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6692Medicare PIN
FLD60708Medicare UPIN