Individual
CORY JOSEPH HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4495
(505) 842-8171
(505) 246-0684
Mailing address
4273 MONTGOMERY BLVD NE, SUITE 200 E, ALBUQUERQUE, NM 87109-6748
(505) 821-5992
(505) 821-6692
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
BP10027616
TX
207R00000X
Internal Medicine Physician
N7105
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
N7105
TX
207RP1001X
Pulmonary Disease Physician
Primary
N7105
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55236251
—
NM
01
—
MD2014-0172
MEDICAL LICENSE
NM
01
—
N7105
MEDICAL LICENSE
TX
Enumeration date
07/12/2007
Last updated
05/15/2020
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