Provider Demographics
NPI:1194894816
Name:PINKSTAFF, JOHN EDMOND (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDMOND
Last Name:PINKSTAFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17472 CREEK XING
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5523
Mailing Address - Country:US
Mailing Address - Phone:409-256-5817
Mailing Address - Fax:
Practice Address - Street 1:17472 CREEK XING
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5523
Practice Address - Country:US
Practice Address - Phone:409-256-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5014207P00000X
TXM6831207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine