Provider Demographics
NPI:1376705947
Name:PICKARD GOSSETT SAWISKY LLP
Entity Type:Organization
Organization Name:PICKARD GOSSETT SAWISKY LLP
Other - Org Name:GOSSETT HAMMETT SAWISKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ODIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-722-0026
Mailing Address - Street 1:2501 JIMMY JOHNSON BLVD
Mailing Address - Street 2:STE 307
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2000
Mailing Address - Country:US
Mailing Address - Phone:409-722-0026
Mailing Address - Fax:409-792-0201
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD
Practice Address - Street 2:STE 307
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2000
Practice Address - Country:US
Practice Address - Phone:409-722-0026
Practice Address - Fax:409-792-0201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PICKARD GOSSETT & SAWISKY LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0066JQOtherBLUE CROSS