Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 27987 | OK |
NPI | 1003805789 |
---|---|
Provider Name | Dr. John Lance Pickard |
First Address | Dallas, TX 75246-1800 |
Second Address | Flower Mound, TX 75028-1712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 31/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045329202 | (05) | TX |
045329203 | (05) | TX |