Provider Demographics
NPI:1396971727
Name:HICKS, BENJAMIN FERRILL JR (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FERRILL
Last Name:HICKS
Suffix:JR
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 1:1330 CREST ROAD
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2529
Mailing Address - Country:US
Mailing Address - Phone:858-755-8770
Mailing Address - Fax:858-755-8770
Practice Address - Street 1:1330 CREST ROAD
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2529
Practice Address - Country:US
Practice Address - Phone:858-755-8770
Practice Address - Fax:858-755-8770
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine