Provider Demographics
NPI:1902964075
Name:PICKETT, H MANING (MD)
Entity Type:Individual
Prefix:MR
First Name:H
Middle Name:MANING
Last Name:PICKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1805 KIPLING ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215
Mailing Address - Country:US
Mailing Address - Phone:303-232-3232
Mailing Address - Fax:303-232-8922
Practice Address - Street 1:1805 KIPLING ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215
Practice Address - Country:US
Practice Address - Phone:303-232-3232
Practice Address - Fax:303-232-8922
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E05717Medicare UPIN
CO01187210Medicare ID - Type Unspecified
A6908Medicare ID - Type Unspecified