Healthcare Provider Details

I. General information

NPI: 1902980410
Provider Name (Legal Business Name): LAURENS RUSSELL PICKARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST SUITE 1846
HOUSTON TX
77030-2761
US

IV. Provider business mailing address

PO BOX 128
BELLAIRE TX
77402-0128
US

V. Phone/Fax

Practice location:
  • Phone: 713-797-1211
  • Fax: 713-795-9805
Mailing address:
  • Phone: 281-833-3330
  • Fax: 281-833-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD7249
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberD7249
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD7249
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: