Healthcare Provider Details

I. General information

NPI: 1003805789
Provider Name (Legal Business Name): JOHN LANCE PICKARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LANCE PICKARD MD

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 MEDICAL ARTS DR SUITE 105
FLOWER MOUND TX
75028-1712
US

IV. Provider business mailing address

3600 GASTON AVE SUITE 1205
DALLAS TX
75246-1800
US

V. Phone/Fax

Practice location:
  • Phone: 214-691-1902
  • Fax: 214-513-2059
Mailing address:
  • Phone: 214-692-8262
  • Fax: 214-696-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number27987
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: