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NPI Code Detail

MEDICARE: DR. FRED L. PICKLESIMER JR. M.D.

MEDICARE: DR. FRED L. PICKLESIMER JR. 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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician37331KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699774992
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRED L. PICKLESIMER JR. M.D.
Provider Business Mailing Address
First Line : 1355 RIVER BEND DR
Second Line :
City : DALLAS
State : TX
Zip : 75247-4915
Country : US
Telephone Number : 214-237-1818
Fax Number : 844-751-9263
Provider Business Practice Location Address
First Line : 706 GREEN VALLEY RD STE 104
Second Line :
City : GREENSBORO
State : NC
Zip : 27408-7043
Country : US
Telephone Number : 336-387-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 10/17/2023

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