Provider Demographics
NPI:1982619003
Name:HICKS, GREGORY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:HICKS
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 1:5200 DTC PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2709
Mailing Address - Country:US
Mailing Address - Phone:303-745-0000
Mailing Address - Fax:303-708-1834
Practice Address - Street 1:5200 DTC PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2709
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-708-1834
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0045250207R00000X
COCO45250208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361037691Medicaid
IL623665OtherHEALTHLINK
IL076588OtherHEALTH ALLIANCE
CO60776773Medicaid
ILP00063221OtherRAILROAD MEDICARE
IL7215059OtherBCBS PPO
ILIL01V9OtherJOHN DEERE
ILW23820Medicare UPIN
COCO301987Medicare PIN