Hicks, Larry Charles

Hicks, Larry Charles is an individual health care provider with primary practice located at 1441 Florida , Modesto CA 95352. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Hicks, Larry Charles can be contacted via phone (209) 576-3999.

Contact Information

Primary practice address
1441 Florida Modesto CA 95352
Phone: (209) 576-3999
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X

Profile Details

NPI number 1568453801
LBN Legal business name Hicks, Larry Charles
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 4th, 2005
Last updated Jan 11th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568453801 NPPES
California Other CD069A GROUP PTAN
California Other OPA108440 GROUP PTAN
California MEDICAID OPA108440 GROUP PTAN

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