Provider Demographics
NPI:1508085655
Name:HICKMAN, DONN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DONN
Middle Name:MICHAEL
Last Name:HICKMAN
Suffix:
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 1:920 E WARDLOW RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4630
Mailing Address - Country:US
Mailing Address - Phone:562-988-0365
Mailing Address - Fax:562-427-4086
Practice Address - Street 1:4401 ATLANTIC AVE STE 101
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2260
Practice Address - Country:US
Practice Address - Phone:562-422-5902
Practice Address - Fax:562-422-6014
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG034964174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist