Provider Demographics
NPI:1669489126
Name:HICKMAN, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5012 US HWY 75 S, SUITE 300
Mailing Address - Street 2:ATT: BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:806-351-7540
Mailing Address - Fax:806-351-7546
Practice Address - Street 1:1900 SE 34TH AVE
Practice Address - Street 2:UNIT 1800
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-7771
Practice Address - Country:US
Practice Address - Phone:806-351-7540
Practice Address - Fax:806-351-7546
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH6847207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135766709Medicaid
TXD51378Medicare UPIN
TX135766709Medicaid