MEDICARE: DR. LAURENS RUSSELL PICKARD MD

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	208600000X	Surgery Physician	D7249	TX
2	2086S0120X	Pediatric Surgery Physician	D7249	TX
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	D7249	TX

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	:	1902980410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURENS RUSSELL PICKARD MD

Provider Business Mailing Address
First Line	:	PO BOX 128
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77402-0128
Country	:	US
Telephone Number	:	281-833-3330
Fax Number	:	281-833-3323

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST
Second Line	:	SUITE 1846
City	:	HOUSTON
State	:	TX
Zip	:	77030-2761
Country	:	US
Telephone Number	:	713-797-1211
Fax Number	:	713-795-9805

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/06/2013

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