Provider Demographics
NPI:1689762411
Name:HICKMAN, LINDA MARIE (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-3754
Mailing Address - Country:US
Mailing Address - Phone:918-225-5377
Mailing Address - Fax:
Practice Address - Street 1:500 LOU ALLARD DR
Practice Address - Street 2:
Practice Address - City:DRUMRIGHT
Practice Address - State:OK
Practice Address - Zip Code:74030-4800
Practice Address - Country:US
Practice Address - Phone:918-352-2555
Practice Address - Fax:918-352-4709
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG17473Medicare UPIN