Provider Demographics
NPI:1821100827
Name:HICKS, CARL A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
Last Name:HICKS
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 1:16811 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4728
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:
Practice Address - Street 1:16811 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4728
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3576207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104542901Medicaid
TX104542908Medicaid
TX104542904Medicaid
TX104542905Medicaid
TXP01055718OtherRR MEDICARE
TX687360OtherAETNA
TX8BP178OtherBLUE CROSS BLUE SHIELD
TXP00732733OtherRAILROAD MEDICARE
TX610119705OtherUS DEPT OF LABOR
TX104542906Medicaid
TX104542903Medicaid
TXTXB151319Medicare PIN
F80283Medicare UPIN
TX8L9966Medicare PIN
TX501678ZSVEMedicare PIN
TX8BP178OtherBLUE CROSS BLUE SHIELD
TX104542906Medicaid
TX104542904Medicaid
TX501678ZSWDMedicare PIN