Individual
PHILLIP HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 N 2ND ST, CLINTON, MO 64735-1192
(660) 890-7103
Mailing address
2003 EPICUREAN DR, CLINTON, MO 64735-1887
(660) 890-7103
(660) 885-8496
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
122530
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
915043905
—
MO
Enumeration date
01/16/2007
Last updated
08/18/2010
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