Provider Demographics
NPI:1508086323
Name:DAVID R. FICKLEN, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID R. FICKLEN, M.D., P.A.
Other - Org Name:TURTLE CREEK MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:FICKLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-435-0014
Mailing Address - Street 1:102 MEDICAL PARK LN STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4975
Mailing Address - Country:US
Mailing Address - Phone:936-435-0014
Mailing Address - Fax:936-435-9108
Practice Address - Street 1:102 MEDICAL PARK LN STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4975
Practice Address - Country:US
Practice Address - Phone:936-435-0014
Practice Address - Fax:936-435-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5929261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1642985-01Medicaid
TX1642985-01Medicaid