Individual
DR. STANLEY MICHAEL HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 LINCOLN ST, SUITE 100, KELSO, WA 98626-1057
(360) 425-5131
Mailing address
700 LINCOLN ST, SUITE 100, KELSO, WA 98626-1057
(360) 425-5131
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD00029538
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040803
OREGON DSHS
OR
01
—
34871
LABOR & INDUSTRIES
WA
05
—
8136988
—
WA
Enumeration date
01/17/2006
Last updated
07/09/2007
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