MEDICARE: JAMES ELWOOD PICKETT III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G3694	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	742732278	OTHER	TX	TAX ID
3	85X691	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1497863112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ELWOOD PICKETT III MD

Provider Business Mailing Address
First Line	:	1300 WONDER WORLD DR
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-7575
Country	:	US
Telephone Number	:	512-353-1300
Fax Number	:	512-353-5135

Provider Business Practice Location Address
First Line	:	2430 S IH 35 STE 106
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-5921
Country	:	US
Telephone Number	:	512-353-1300
Fax Number	:	512-353-5135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	10/28/2020

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