Provider Demographics
NPI:1972812972
Name:PINCKARD, J KEITH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:KEITH
Last Name:PINCKARD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OFFICE OF THE MEDICAL INVESTIGATOR
Mailing Address - Street 2:MSC07 4040, 1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-925-3053
Mailing Address - Fax:505-925-0546
Practice Address - Street 1:OFFICE OF THE MEDICAL INVESTIGATOR
Practice Address - Street 2:MSC07 4040, 1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-925-3053
Practice Address - Fax:505-925-0546
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6575207ZF0201X
NMMD2012-0021207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology