Provider Demographics
NPI:1609862358
Name:HIKES, RYAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:HIKES
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 1:1000 VALE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5218
Mailing Address - Country:US
Mailing Address - Phone:760-631-5000
Mailing Address - Fax:760-414-3892
Practice Address - Street 1:1000 VALE TERRACE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5218
Practice Address - Country:US
Practice Address - Phone:760-631-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424475207Q00000X
CAC178170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391960OtherMEDICARE FQHC
PAG920-0130/KDM4CUOtherCAREFIRST
PA25-1716306026OtherHEALTH NET/TRICARE
PA50091159OtherCAPITAL BLUECROSS
PA7718691OtherAETNA HMO
PA101220398 0003Medicaid
PA1007307260034OtherMEDICAID GROUP #
PA1609862358OtherHEALTH AMERICA
PA25-1716306OtherINTERGROUP
PA25-1716306OtherMULTIPLAN/PHCS
PA7718691OtherAETNA NON-HMO
PA867633OtherMEDICARE GROUP #
PA25-1716306OtherINFORMED
PA120420401OtherDEPT OF LABOR
PAMD424475OtherLICENSE
PAP00746189OtherRAILROAD MEDICARE
PA100728880Medicaid
PA1609862358OtherFIRST HEALTH
PA25-1716306OtherGREATWEST HEALTHCARE
PA25-1716306OtherDEVON HEALTH
PA284822OtherUNISON
PAHI1679713OtherHIGHMARK BLUESHIELD
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA1609862358OtherHEALTH AMERICA
PA25-1716306OtherINTERGROUP