Provider Demographics
NPI:1093799033
Name:PICKARD, WAYNE ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ARTHUR
Last Name:PICKARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 861342
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-1342
Mailing Address - Country:US
Mailing Address - Phone:813-985-5992
Mailing Address - Fax:813-985-5982
Practice Address - Street 1:119 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5779
Practice Address - Country:US
Practice Address - Phone:813-985-5992
Practice Address - Fax:813-985-5982
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33661207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95643OtherBCBS
FL068109100Medicaid
050043966OtherRAILROAD MEDICARE
FL95643OtherBCBS
050043966OtherRAILROAD MEDICARE