Active NPI
Paul H Wick, MD
- Psychiatry Physician
- Tyler, TX
National Provider Identifier
1528034204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- C9183
- Practice address
- 1909 Rickety LN
Tyler, TX 75703-1702 - Phone
- (903) 561-1840
- NPI assigned
- Feb 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | C9183 | TX | Primary |
Addresses
Primary practice location
1909 Rickety LN
Tyler, TX 75703-1702
Mailing address
PO Box 9817
Tyler, TX 75711-2817
Phone (903) 561-1840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102801102 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337817600000",
"number": "1528034204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9817",
"city": "TYLER",
"state": "TX",
"postal_code": "757112817",
"telephone_number": "903-561-1840",
"fax_number": "903-561-4140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1909 RICKETY LN",
"city": "TYLER",
"state": "TX",
"postal_code": "757031702",
"telephone_number": "903-561-1840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICK",
"first_name": "PAUL",
"middle_name": "H",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-23",
"last_updated": "2012-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "C9183",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102801102",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.