Individual
DR. JOHN BENTON HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-0816
(434) 243-3090
Mailing address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-0816
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2021013944
MO
207RG0100X
Gastroenterology Physician
Primary
0116036188
VA
208D00000X
General Practice Physician
2021013944
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200060789
—
MO
Enumeration date
06/20/2018
Last updated
02/27/2025
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