Provider Demographics
NPI:1952711079
Name:STICKLES, JIMMY L (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:L
Last Name:STICKLES
Suffix:
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 1:1400 N INTERSTATE 35
Mailing Address - Street 2:SUITE C2.230
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8221
Mailing Address - Fax:
Practice Address - Street 1:1400 N INTERSTATE 35
Practice Address - Street 2:SUITE C2.230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1926
Practice Address - Country:US
Practice Address - Phone:512-324-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050635207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine