Provider Demographics
NPI:1780079699
Name:HICKS, ROBERT MORGAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MORGAN
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BOBBY
Other - Middle Name:MORGAN
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 80391
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91716-8391
Mailing Address - Country:US
Mailing Address - Phone:415-884-3415
Mailing Address - Fax:415-883-0877
Practice Address - Street 1:1101 VAN NESS AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6919
Practice Address - Country:US
Practice Address - Phone:415-600-3232
Practice Address - Fax:415-447-6335
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CAA1468102085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology