Healthcare Provider Details

I. General information

NPI: 1669472940
Provider Name (Legal Business Name): WILLIAM S PICKENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N E ST SUITE 331
PENSACOLA FL
32501-6339
US

IV. Provider business mailing address

1717 NORTH E STREET SUITE 333
PENSACOLA FL
32501
US

V. Phone/Fax

Practice location:
  • Phone: 850-444-1717
  • Fax: 850-857-1747
Mailing address:
  • Phone: 850-444-1717
  • Fax: 850-857-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME23808
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME7968
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME23808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: