Healthcare Provider Details

I. General information

NPI: 1235150723
Provider Name (Legal Business Name): JAMES ALLAN PICKENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY ST 4TH FLOOR, NICU
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

2108 INLAND HARBOR DR
EDMOND OK
73013-8636
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-6051
  • Fax: 405-949-6977
Mailing address:
  • Phone: 405-348-8092
  • Fax: 405-949-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number16199
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: