Provider Demographics
NPI:1558757245
Name:PICKRELL, BRENT BOWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:BOWEN
Last Name:PICKRELL
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:BWH
Mailing Address - Street 2:75 FRANCIS STREET
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-732-5500
Mailing Address - Fax:
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 2200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2476
Practice Address - Country:US
Practice Address - Phone:323-264-7600
Practice Address - Fax:323-261-8027
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1769832082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program