Provider Demographics
NPI:1750330429
Name:HICKS, LEON MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:MILTON
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2955 HARRISON ST
Mailing Address - Street 2:STE 201
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1154
Mailing Address - Country:US
Mailing Address - Phone:409-892-4561
Mailing Address - Fax:409-892-1775
Practice Address - Street 1:2955 HARRISON ST
Practice Address - Street 2:STE 201
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1154
Practice Address - Country:US
Practice Address - Phone:409-892-4561
Practice Address - Fax:409-892-1775
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE00532086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16892Medicare UPIN