Individual
DR. LAURENCE V HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
236 MARTIN ST, TWIN FALLS, ID 83301-4542
(208) 733-4444
(208) 733-4456
Mailing address
236 MARTIN ST, TWIN FALLS, ID 83301-4542
(208) 733-4444
(208) 733-4456
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-180
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80416400
—
ID
Enumeration date
09/13/2006
Last updated
06/11/2019
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