Provider Demographics
NPI:1710999412
Name:PICKETT, JAN W (MD)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:W
Last Name:PICKETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6600 PAIGE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4500
Mailing Address - Country:US
Mailing Address - Phone:972-625-5442
Mailing Address - Fax:972-370-2301
Practice Address - Street 1:6600 PAIGE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-4500
Practice Address - Country:US
Practice Address - Phone:972-625-5442
Practice Address - Fax:972-370-2301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2013-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH2690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7123648OtherCIGNA
TX8F0090OtherBLUE CROSS BLUE SHIELD
TX4411397OtherAETNA
TX010064924OtherRAILROAD MEDICARE
TX4411397OtherAETNA
TXC20513Medicare UPIN