Individual
DR. MARY VAN SICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7777 SOUTHWEST FWY, STE 616, HOUSTON, TX 77074-1802
(713) 773-3983
(713) 271-4076
Mailing address
PO BOX 6880, SANTA FE, NM 87502-6880
(505) 395-2288
(505) 983-8135
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
H5211
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0063PA
BLUE CROSS ID
TX
Enumeration date
06/01/2005
Last updated
06/28/2017
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