Healthcare Provider Details

I. General information

NPI: 1083632095
Provider Name (Legal Business Name): ALBERT MICHAEL PICKLE R, MR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E 23RD ST
PANAMA CITY FL
32405-5307
US

IV. Provider business mailing address

2201 ANDREWS RD
LYNN HAVEN FL
32444-5399
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-8822
  • Fax: 850-747-8664
Mailing address:
  • Phone: 850-248-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number35380
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number256881
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: