Healthcare Provider Details

I. General information

NPI: 1124048467
Provider Name (Legal Business Name): JOHN PIXLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST # MS 9410
LUBBOCK TX
79430-0002
US

IV. Provider business mailing address

3601 4TH ST # MS 9410
LUBBOCK TX
79430-0002
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-3155
  • Fax: 806-743-3148
Mailing address:
  • Phone: 806-743-3155
  • Fax: 806-743-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number5574
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: