Provider Demographics
NPI:1497863112
Name:PICKETT, JAMES ELWOOD III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ELWOOD
Last Name:PICKETT
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 WONDER WORLD DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7575
Mailing Address - Country:US
Mailing Address - Phone:512-353-1300
Mailing Address - Fax:512-353-5135
Practice Address - Street 1:2430 S IH 35 STE 106
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5921
Practice Address - Country:US
Practice Address - Phone:512-353-1300
Practice Address - Fax:512-353-5135
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2020-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG3694207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120321802Medicaid
TX742732278OtherTAX ID
TX85X691OtherBCBS
TX85X691Medicare ID - Type Unspecified
TX120321802Medicaid