Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 97-34 | NM |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 97-34 | NM |
NPI | 1487733192 |
---|---|
Provider Name | Bradley P. Pickett |
First Address | Albuquerque, NM 87102-1726 |
Second Address | Albuquerque, NM 87106-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 07/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
384941 | (05) | AZ |
G24691 | (02) | NM |
Q2517 | (05) | NM |