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Larry Charles Hicks, PA
Surgical Physician Assistant in Modesto, California
NPI 1568453801

Larry Charles Hicks is a Surgical Physician Assistant based in Modesto, CA and is specialized in Surgical. Larry Charles Hicks practices in Modesto, CA and has the professional credentials of PA. The NPI Number for Larry Charles Hicks is 1568453801 and holds a License No. (California).

The current practice location address for Larry Charles Hicks is 1441 Florida, Modesto, CA and can be reached out via phone at 209-576-3999.

Location: 1441 Florida, Modesto, CA, 95356-9262
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Provider Profile Details
NPI Number
1568453801
Provider Name
Larry Charles Hicks
Credential
PA
Provider Entity Type
Individual
Gender
Male
Address
1441 Florida, Modesto, CA, 95356-9262
Phone Number
209-576-3999
Fax Number
Provider Enumeration Date
11/04/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
CD069A 01 CA GROUP PTAN
OPA108440 01 CA BLUE SHIELD
OPA108440 05 CA
institution
Provider Business Practice Location Address Details
Address
1441 Florida
City
State
Zip
95352
Phone Number
209-576-3999
Fax Number
person
Provider Business Mailing Address Details
Address
1441 Florida
City
State
Zip
95352
Phone Number
209-576-3999
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
()
Definition
Definition to come...
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