Provider Demographics
NPI:1720070816
Name:HICKS, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
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 1:1000 S RODNEY PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-2476
Mailing Address - Country:US
Mailing Address - Phone:501-221-0888
Mailing Address - Fax:501-221-2769
Practice Address - Street 1:1000 S RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2476
Practice Address - Country:US
Practice Address - Phone:501-221-0888
Practice Address - Fax:501-221-2769
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR52194OtherBLUE CROSS BLUE SHIELD
AR11119000000OtherQUALCHOICE
AR120101OtherUNITED HEALTHCARE
ARC68450Medicare UPIN
AR52194Medicare ID - Type Unspecified