Provider Demographics
NPI:1487679841
Name:PICKARD, PAUL W (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
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 851417
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-1417
Mailing Address - Country:US
Mailing Address - Phone:251-342-3000
Mailing Address - Fax:251-342-3043
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-342-3000
Practice Address - Fax:251-342-3043
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14818207L00000X
MS15000207L00000X
LAMD207394207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL107425Medicaid
AL107512Medicaid
MS00116715Medicaid
MS00116715Medicaid
MSE20841Medicare UPIN
MSE20841Medicare UPIN