Provider Demographics
NPI:1932293016
Name:PICKENS, STEVEN GEOFFERY (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:GEOFFERY
Last Name:PICKENS
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 1:603 W UNIVERSITY
Mailing Address - Street 2:STE 110
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6685
Mailing Address - Country:US
Mailing Address - Phone:512-930-4776
Mailing Address - Fax:512-863-4248
Practice Address - Street 1:603 W UNIVERSITY
Practice Address - Street 2:STE 110
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6685
Practice Address - Country:US
Practice Address - Phone:512-930-4776
Practice Address - Fax:512-863-4248
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6514208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F86833Medicare UPIN