Provider Demographics
NPI:1548446560
Name:PICKENS, JAMES ELIOT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ELIOT
Last Name:PICKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:425 MEDICAL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4945
Mailing Address - Country:US
Mailing Address - Phone:801-455-9667
Mailing Address - Fax:801-335-0535
Practice Address - Street 1:425 MEDICAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4945
Practice Address - Country:US
Practice Address - Phone:801-455-9667
Practice Address - Fax:801-335-0535
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150617-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist