Provider Demographics
NPI:1003805789
Name:PICKARD, JOHN LANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LANCE
Last Name:PICKARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LANCE
Other - Middle Name:
Other - Last Name:PICKARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:4370 MEDICAL ARTS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1712
Practice Address - Country:US
Practice Address - Phone:214-691-1902
Practice Address - Fax:214-513-2059
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27987208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045329203Medicaid
TX045329202Medicaid
TX506315YND4Medicare PIN
TX045329203Medicaid
TX506315YNEDMedicare PIN
TX045329202Medicaid