Provider Demographics
NPI:1114935418
Name:PICKRELL, PAUL K (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:PICKRELL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:12912 HILL COUNTRY BLVD
Mailing Address - Street 2:BLDG F STE 238
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6328
Mailing Address - Country:US
Mailing Address - Phone:512-732-2929
Mailing Address - Fax:512-732-2933
Practice Address - Street 1:12912 HILL COUNTRY BLVD
Practice Address - Street 2:BLDG F STE 238
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6328
Practice Address - Country:US
Practice Address - Phone:512-732-2929
Practice Address - Fax:512-732-2933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT11711039-1205207RR0500X
TXK0997207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8216M0Medicare PIN
TXG28066Medicare UPIN