Healthcare Provider Details

I. General information

NPI: 1609831833
Provider Name (Legal Business Name): GREG DANIEL PICKETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E PECAN ST
ALTUS OK
73521-6141
US

IV. Provider business mailing address

304 S PARK LN
ALTUS OK
73521-5753
US

V. Phone/Fax

Practice location:
  • Phone: 580-379-5000
  • Fax: 580-379-5509
Mailing address:
  • Phone: 580-379-6500
  • Fax: 580-379-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4548
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: