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Individual
DR. TIMOTHY W HICKERSON
Active
Individual
DR. TIMOTHY W HICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35055407
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000015901
ANTHEM
OH
05
—
0771937
—
OH
Enumeration date
07/28/2005
Last updated
02/12/2008
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