Provider Demographics
NPI:1801846068
Name:PICO, JUAN SAYSON (DO)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:SAYSON
Last Name:PICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8109 FREDERICKSBURG RD
Mailing Address - Street 2:PHYSICIAN PRACTICE SERVICES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3311
Mailing Address - Country:US
Mailing Address - Phone:210-650-9669
Mailing Address - Fax:210-650-0750
Practice Address - Street 1:12702 N IH 35
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2609
Practice Address - Country:US
Practice Address - Phone:210-650-9669
Practice Address - Fax:210-650-0750
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102049959207R00000X
TXL5514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213809103Medicaid
P01169315OtherRAILROAD MEDICARE
TX8DL502OtherBCBSTX
TXB161244Medicare PIN
TX8L26431Medicare PIN