Provider Demographics
NPI:1205167889
Name:PITTMAN, MICHAEL RAY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:PITTMAN
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 1:9400 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 124-606
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4705
Mailing Address - Country:US
Mailing Address - Phone:214-631-3663
Mailing Address - Fax:469-384-3917
Practice Address - Street 1:413 W BETHEL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4473
Practice Address - Country:US
Practice Address - Phone:214-493-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG89452084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry