Individual
MR. JAMES MURRAY HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
516 NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1253
Mailing address
516 NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1253
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
119
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
119
MONTANA PA LICENSE
MT
05
—
18207031
—
NM
01
—
746779
AHCCCS NUMBER
—
Enumeration date
03/14/2006
Last updated
07/09/2007
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