Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | F7053 | TX |
Y | 207RI0011X | Interventional Cardiology | F7053 | TX |
NPI | 1003904962 |
---|---|
Provider Name | James Dwayne Pickett |
First Address | Conroe, TX 77304-2808 |
Second Address | Conroe, TX 77304-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 15/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123004705 | (05) | TX |
C20512 | (02) | TX |