Provider Demographics
NPI:1326044520
Name:HICKS, RONALD B II (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:HICKS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E PRATER WAY
Mailing Address - Street 2:STE 301
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9639
Mailing Address - Country:US
Mailing Address - Phone:775-352-3520
Mailing Address - Fax:775-352-3523
Practice Address - Street 1:5975 S LOS ALTOS PKWY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7699
Practice Address - Country:US
Practice Address - Phone:775-204-4000
Practice Address - Fax:775-204-4001
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1326044520Medicaid
NV002016563Medicaid
30493Medicare ID - Type Unspecified