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Dr. Samuel Hickey JR.
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NPI Number Detailed Information
Provider Information:
Name: | Dr. Samuel Hickey JR. |
Gender: | M |
Provider License Number If Given: | 24236 |
NPI Information:
NPI: | 1205835717 |
Entity Type (Individual or Organization): |
1-ind |
Enumeration Date: | 7/18/2005 |
Last Update Date: | 11/17/2011 |
Provider Business Mailing Address:
Address: | 42440 PELICAN PROFESSIONAL PARK Hammond, LA 70403 |
Phone Number: | 9855424950 |
Fax Number: | 9855426089 |
Provider Business Practice Location Address:
Address: | 42440 PELICAN PROFESSIONAL PARK Hammond, LA 70403 |
Phone Number: | 9855424950 |
Fax Number: | 9855426089 |
Provider Taxonomy:
Primary: | 208000000X |
Secondary (if any): | |
State: | LA |