Provider Demographics
NPI:1235196163
Name:HICKSON, LORI ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:HICKSON
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 1:1619 E. COMMON ST.
Mailing Address - Street 2:BLDG. L, SUITE 1201
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-203-6695
Mailing Address - Fax:830-214-6292
Practice Address - Street 1:1619 E. COMMON ST.
Practice Address - Street 2:BLDG. L, SUITE 1201
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-203-6695
Practice Address - Fax:830-214-6292
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76559207R00000X
TXP2259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA76559AMedicare ID - Type Unspecified
CAG98751Medicare UPIN