Provider Demographics
NPI:1508975756
Name:SCHICKNER, DAVID JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:SCHICKNER
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:PO BOX 20635
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-0635
Mailing Address - Country:US
Mailing Address - Phone:254-292-1090
Mailing Address - Fax:254-292-1100
Practice Address - Street 1:1105 WOODED ACRES DR
Practice Address - Street 2:SUITE 240
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4468
Practice Address - Country:US
Practice Address - Phone:254-292-1090
Practice Address - Fax:254-292-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110457201Medicaid
TX110457201Medicaid