Provider Demographics
NPI:1669451050
Name:HICKS, MARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2370 DREW ST
Mailing Address - Street 2:STE B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3310
Mailing Address - Country:US
Mailing Address - Phone:727-461-1543
Mailing Address - Fax:727-449-0594
Practice Address - Street 1:2370 DREW ST
Practice Address - Street 2:STE B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3310
Practice Address - Country:US
Practice Address - Phone:727-461-1543
Practice Address - Fax:727-449-0594
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME88392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268120000Medicaid