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General NPI Number Information
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NPI Number | 1528369576
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Entity Type | Individual
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Provider Name | BRIAN M PICKENS PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 2121 HUGHES DR # 310
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City | TOLEDO
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State | OH
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Zip | 43606-3845
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Country | US
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Telephone | 419-291-3858
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Fax | 419-480-8701
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Provider Business Mailing Address
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Address Line | 2121 HUGHES DR # 310
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City | TOLEDO
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State | OH
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Zip | 43606-3845
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Country | US
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Telephone | 419-291-3858
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Fax | 419-480-8701
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 50003098
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License Number State | OH
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