Provider Demographics
NPI:1669472940
Name:PICKENS, WILLIAM S (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:PICKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 NORTH E STREET
Mailing Address - Street 2:SUITE 333
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501
Mailing Address - Country:US
Mailing Address - Phone:850-444-1717
Mailing Address - Fax:850-857-1747
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 331
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-444-1717
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME23808207RI0011X, 207RC0000X
ALME7968207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009304090Medicaid
FL0579106 00Medicaid
AL009304090Medicaid
FLD58158Medicare UPIN