Provider Demographics
NPI:1710201926
Name:DAVID J. SCHICKNER, M.D. , P.A.
Entity Type:Organization
Organization Name:DAVID J. SCHICKNER, M.D. , P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-292-1090
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 STE 240
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4449
Practice Address - Country:US
Practice Address - Phone:254-292-1090
Practice Address - Fax:254-292-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty