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General NPI Number Information
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NPI Number | 1346283629
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Entity Type | Individual
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Provider Name | JOHN BRADLEY PICKHARDT MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 500 W BROADWAY
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City | MISSOULA
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State | MT
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Zip | 59802-4008
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Country | US
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Telephone | 406-542-7525
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Fax | 406-829-0661
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Provider Business Mailing Address
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Address Line | PO BOX 7817
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City | MISSOULA
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State | MT
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Zip | 59807-7817
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Country | US
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Telephone | 406-542-7525
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Fax | 406-829-0661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 6635
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License Number State | MT
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