Healthcare Provider Details

I. General information

NPI: 1154428621
Provider Name (Legal Business Name): GARFIELD CAMERON PICKELL M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 SPYRES WAY
MODESTO CA
95356-9259
US

IV. Provider business mailing address

4368 SPYRES WAY
MODESTO CA
95356-9259
US

V. Phone/Fax

Practice location:
  • Phone: 209-578-6357
  • Fax: 209-883-3290
Mailing address:
  • Phone: 209-578-6357
  • Fax: 209-883-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA41759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: