Provider Demographics
NPI:1487888269
Name:ROBERT E. PICKARD, MD, PA
Entity type:Organization
Organization Name:ROBERT E. PICKARD, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-661-9100
Mailing Address - Street 1:7000 SW 62ND AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4716
Mailing Address - Country:US
Mailing Address - Phone:305-661-9100
Mailing Address - Fax:305-661-2238
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-661-9100
Practice Address - Fax:305-661-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14669261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD67401Medicare UPIN