Individual
MR. JAYSON DOUGLAS HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
113 W RIVER PKWY, CHAMPLIN, MN 55316-1316
(612) 801-2745
Mailing address
113 W RIVER PKWY, CHAMPLIN, MN 55316-1316
(612) 801-2745
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA954
NV
Other
Enumeration date
03/07/2012
Last updated
03/07/2012
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