Provider Demographics
NPI:1982610408
Name:PICKENS, JAMES W (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:PICKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1305 W JEFFERSON
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165
Mailing Address - Country:US
Mailing Address - Phone:972-351-9182
Mailing Address - Fax:972-351-9187
Practice Address - Street 1:1305 W JEFFERSON
Practice Address - Street 2:SUITE 110
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-351-9182
Practice Address - Fax:972-351-9187
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038NWOtherBCBS
TX124229902Medicaid
TX124229906Medicaid
TX124229905Medicaid
TX4079994OtherAETNA INS
C20508Medicare UPIN
TX4079994OtherAETNA INS
806614Medicare ID - Type Unspecified
TXTXB143953Medicare PIN