Provider Demographics
NPI:1427160118
Name:HICKMAN, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:HICKMAN
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 1:598 N UNION AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4179
Mailing Address - Country:US
Mailing Address - Phone:830-625-6259
Mailing Address - Fax:
Practice Address - Street 1:598 N UNION AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4136
Practice Address - Country:US
Practice Address - Phone:830-625-6259
Practice Address - Fax:830-625-6607
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3461208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D03KOtherBCBS OF TEXAS
TX120477801Medicaid
TX020009056OtherMEDICARE RAILROAD
TX7425494727813000000OtherTRICARE
TX00D03KOtherBCBS OF TEXAS
TXC16890Medicare UPIN