Provider Demographics
NPI:1346283629
Name:PICKHARDT, JOHN BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRADLEY
Last Name:PICKHARDT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7817
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7817
Mailing Address - Country:US
Mailing Address - Phone:406-542-7525
Mailing Address - Fax:406-829-0661
Practice Address - Street 1:500 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4008
Practice Address - Country:US
Practice Address - Phone:406-542-7525
Practice Address - Fax:406-829-0661
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT6635208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery