Provider Demographics
NPI:1922299643
Name:HICKLE, FRED W (PA)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:W
Last Name:HICKLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1005 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1832
Mailing Address - Country:US
Mailing Address - Phone:724-532-1020
Mailing Address - Fax:724-532-1025
Practice Address - Street 1:1005 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1832
Practice Address - Country:US
Practice Address - Phone:724-532-1020
Practice Address - Fax:724-532-1025
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant