Basic Information
| Provider Information | |||||||||
| NPI: | 1700945474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HICKS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 826 W 27TH AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992031838 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 N SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | OGALLALA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691532465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082843645 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD00043363 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | E-5163 | AR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | ND-11439-A | NE | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.