Healthcare Provider Details

I. General information

NPI: 1972812972
Provider Name (Legal Business Name): J KEITH PINCKARD M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2010
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OFFICE OF THE MEDICAL INVESTIGATOR MSC07 4040, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

OFFICE OF THE MEDICAL INVESTIGATOR MSC07 4040, 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-3053
  • Fax: 505-925-0546
Mailing address:
  • Phone: 505-925-3053
  • Fax: 505-925-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberL6575
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberMD2012-0021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: