Provider Demographics
NPI:1336422385
Name:HICKS, DANIEL E (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:HICKS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MORNING GLN
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-4955
Mailing Address - Country:US
Mailing Address - Phone:801-870-8921
Mailing Address - Fax:
Practice Address - Street 1:12412 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3255
Practice Address - Country:US
Practice Address - Phone:210-757-5034
Practice Address - Fax:210-510-7260
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21937363AM0700X
TXPA12808363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical