Provider Demographics
NPI:1659377513
Name:HICKEY, DAVID CRAVEN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CRAVEN
Last Name:HICKEY
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 1:8080 STATE HIGHWAY 121
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2901
Mailing Address - Country:US
Mailing Address - Phone:214-906-0829
Mailing Address - Fax:
Practice Address - Street 1:8080 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 350
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2901
Practice Address - Country:US
Practice Address - Phone:214-906-0829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4931207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6620052Medicaid
E04433Medicare UPIN
SD6620052Medicaid