Provider Demographics
NPI:1982676359
Name:PICKETT, CREIGHTON A III (MD)
Entity Type:Individual
Prefix:DR
First Name:CREIGHTON
Middle Name:A
Last Name:PICKETT
Suffix:III
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:P.O. BOX 650252
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265
Mailing Address - Country:US
Mailing Address - Phone:888-804-3000
Mailing Address - Fax:817-334-0235
Practice Address - Street 1:2000 E. LAMAR
Practice Address - Street 2:400
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006
Practice Address - Country:US
Practice Address - Phone:888-804-3000
Practice Address - Fax:817-334-0235
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8966207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150271802Medicaid
H59050Medicare UPIN
8D9801Medicare PIN