MEDICARE: CURTIS PICKERT M.D.

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	208000000X	Pediatrics Physician	G85980	CA
2	2080P0203X	Pediatric Critical Care Medicine Physician	G85980	CA

General Provider Information

NPI Number	:	1508859554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURTIS PICKERT M.D.

Provider Business Mailing Address
First Line	:	3006 S MARYLAND PKWY
Second Line	:	505
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2218
Country	:	US
Telephone Number	:	702-697-0082
Fax Number	:	702-369-5827

Provider Business Practice Location Address
First Line	:	320 W PUEBLO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4311
Country	:	US
Telephone Number	:	702-697-0082
Fax Number	:	702-369-5827

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/07/2007

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