Provider Demographics
NPI:1174588990
Name:HICKS, BARRY A (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1935 MEDICAL DISTRICT DRIVE
Mailing Address - Street 2:PEDIATRIC SURGERY, SUITE D2000
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235
Mailing Address - Country:US
Mailing Address - Phone:214-456-8044
Mailing Address - Fax:214-456-6320
Practice Address - Street 1:1935 MEDICAL DISTRICT DRIVE
Practice Address - Street 2:PEDIATRIC SURGERY, SUITE D2000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:214-456-8044
Practice Address - Fax:214-456-6320
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4379362086S0120X
NJMA086514002086S0120X
DEC100091602086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0208949Medicaid
PA102421891Medicaid
TX044149501Medicaid
MD418355Medicaid
TX044149501Medicaid
TX85A238Medicare ID - Type Unspecified