Provider Demographics
NPI:1720059322
Name:HICKS, ROBB R IV (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBB
Middle Name:R
Last Name:HICKS
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBB
Other - Middle Name:R
Other - Last Name:HICKS
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:500 JUNGERMANN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2774
Mailing Address - Country:US
Mailing Address - Phone:314-680-1632
Mailing Address - Fax:888-955-9047
Practice Address - Street 1:500 JUNGERMANN RD STE 203
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:314-680-1632
Practice Address - Fax:888-955-9047
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2J89208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE48148OtherUPIN
MOE48148OtherUPIN