Provider Demographics
NPI:1467456988
Name:WICKS, ALLAN B (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:B
Last Name:WICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 E HAMPDEN AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2793
Mailing Address - Country:US
Mailing Address - Phone:303-788-8500
Mailing Address - Fax:303-788-8505
Practice Address - Street 1:499 E HAMPDEN AVE
Practice Address - Street 2:STE 300
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2793
Practice Address - Country:US
Practice Address - Phone:303-788-8500
Practice Address - Fax:303-788-8505
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO16825207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01168251Medicaid
COD23137Medicare UPIN
CO87824Medicare ID - Type Unspecified