Healthcare Provider Details

I. General information

NPI: 1114935418
Provider Name (Legal Business Name): PAUL K PICKRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12912 HILL COUNTRY BLVD BLDG F STE 238
AUSTIN TX
78738-6328
US

IV. Provider business mailing address

12912 HILL COUNTRY BLVD BLDG F STE 238
AUSTIN TX
78738-6328
US

V. Phone/Fax

Practice location:
  • Phone: 512-732-2929
  • Fax: 512-732-2933
Mailing address:
  • Phone: 512-732-2929
  • Fax: 512-732-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number11711039-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberK0997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: