Provider Demographics
NPI:1124015821
Name:PICKERING, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:PICKERING
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 1866
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-1866
Mailing Address - Country:US
Mailing Address - Phone:662-890-2663
Mailing Address - Fax:662-890-2681
Practice Address - Street 1:9085 SANDIDGE CENTER CV
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3575
Practice Address - Country:US
Practice Address - Phone:901-861-9610
Practice Address - Fax:901-861-9611
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27978207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200000224Medicare PIN
TNG15977Medicare UPIN
TNG15977Medicare UPIN