Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 11711039-1205 | UT |
Y | 207RR0500X | Rheumatology | K0997 | TX |
NPI | 1114935418 |
---|---|
Provider Name | Paul K Pickrell |
First Address | Austin, TX 78738-6328 |
Second Address | Austin, TX 78738-6328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G28066 | (02) | TX |