MEDICARE: THOMAS BARTLEY PICKRON JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	M2017	TX
2	208C00000X	Colon & Rectal Surgery Physician	93632391205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598733941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS BARTLEY PICKRON JR. M.D.

Provider Business Mailing Address
First Line	:	30 N 1900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0002
Country	:	US
Telephone Number	:	801-581-7124
Fax Number	:	801-585-1520

Provider Business Practice Location Address
First Line	:	30 N 1900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0002
Country	:	US
Telephone Number	:	801-581-7124
Fax Number	:	801-585-1520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	11/11/2021

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