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Individual

THOMAS H HICKERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
14450 SE ROYER RD, CLACKAMAS, OR 97015-8730
(503) 658-5521
(503) 658-5002
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
(503) 658-5521
(503) 658-5002

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD10999
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
240325
OR
05
8438574
WA
Enumeration date
04/17/2006
Last updated
08/09/2010
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