Provider Demographics
NPI:1881985323
Name:WICKS, ROBERT THOMAS (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THOMAS
Last Name:WICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8950 N KENDALL DR STE 407W
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2132
Mailing Address - Country:US
Mailing Address - Phone:305-271-6159
Mailing Address - Fax:305-271-6851
Practice Address - Street 1:8950 N KENDALL DR STE 407W
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2132
Practice Address - Country:US
Practice Address - Phone:305-271-6159
Practice Address - Fax:305-271-6851
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55781207T00000X
FLME151082207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ369049Medicaid