Individual
FRED G. HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11477 OLDE CABIN RD, SUITE 200, SAINT LOUIS, MO 63141-7130
(314) 567-5000
(314) 567-3110
Mailing address
11477 OLDE CABIN RD, SUITE 200, SAINT LOUIS, MO 63141-7130
(314) 567-5000
(314) 567-3110
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
R7D14
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100730
HEALTHLINK
MO
01
—
1581541
UNITED HEALTHCARE
MO
01
—
17058
BLUE CROSS BLUE SHIELD
MO
05
—
202118311
—
MO
01
—
260006282
RR MEDICARE
MO
Enumeration date
08/30/2006
Last updated
10/14/2009
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