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NPI Code Detail

MEDICARE: STUART CHARLES PICKELL MD

MEDICARE: STUART CHARLES PICKELL 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
1207R00000XInternal Medicine PhysicianL2552TX

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 : 1740261114
Entity Type Code : Individual
Provider Name (Legal Business Name) : STUART CHARLES PICKELL MD
Provider Business Mailing Address
First Line : 4400 OAK PARK LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-9534
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4400 OAK PARK LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-9534
Country : US
Telephone Number : 817-985-7772
Fax Number : 817-985-7773
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 03/14/2025

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Directions to “ STUART CHARLES PICKELL MD” Practice Location

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