Individual
JOHN TRIMMER HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
15159
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
571122060
BLUE CROSS/BLUE SHIELD
SC
05
—
GP3287
—
SC
Enumeration date
12/19/2005
Last updated
04/15/2013
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