Provider Demographics
NPI:1154428621
Name:PICKELL, GARFIELD CAMERON (M D)
Entity type:Individual
Prefix:
First Name:GARFIELD
Middle Name:CAMERON
Last Name:PICKELL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4368 SPYRES WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9259
Mailing Address - Country:US
Mailing Address - Phone:209-578-6357
Mailing Address - Fax:209-883-3290
Practice Address - Street 1:4368 SPYRES WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9259
Practice Address - Country:US
Practice Address - Phone:209-578-6357
Practice Address - Fax:209-883-3290
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41759207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01543FMedicaid
CAHPC01543FMedicaid
CAA29455Medicare UPIN
CA051543Medicare ID - Type Unspecified