Provider Demographics
NPI:1740411743
Name:PICKETT, WILLIAM MICHAEL (CST/CFA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:PICKETT
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 COLORADO BLVD
Mailing Address - Street 2:APT# 5118
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4086
Mailing Address - Country:US
Mailing Address - Phone:303-229-5810
Mailing Address - Fax:
Practice Address - Street 1:901 COLORADO BLVD
Practice Address - Street 2:APT# 5118
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4086
Practice Address - Country:US
Practice Address - Phone:303-229-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115792246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant