Individual
DR. JOHN E. HICKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MULLINS DR STE C2, LEBANON, OR 97355-2868
(541) 451-6413
Mailing address
PO BOX 1193, CORVALLIS, OR 97339-1193
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD15378
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155952
—
OR
Enumeration date
06/27/2006
Last updated
02/19/2021
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