Provider Demographics
NPI:1508859554
Name:PICKERT, CURTIS (MD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:PICKERT
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 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:505
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:702-697-0082
Mailing Address - Fax:702-369-5827
Practice Address - Street 1:320 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4311
Practice Address - Country:US
Practice Address - Phone:702-697-0082
Practice Address - Fax:702-369-5827
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85980208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67052Medicare UPIN
CAWG85980CMedicare PIN
NV37593Medicare PIN
LA4K569CY18Medicare PIN
NV101025Medicare PIN