Provider Demographics
NPI:1679624043
Name:PICKETT, JASON RAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RAINE
Last Name:PICKETT
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 1:4201 ED BLUESTEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78721-2909
Mailing Address - Country:US
Mailing Address - Phone:512-978-0000
Mailing Address - Fax:
Practice Address - Street 1:4201 ED BLUESTEIN BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78721-2909
Practice Address - Country:US
Practice Address - Phone:512-978-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089152207PE0004X, 207P00000X
UT13823854-1205207P00000X
OHP0948731146L00000X
WV27856207P00000X
TXR4766207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH272983Medicaid
OH272983Medicaid