Individual
MR. GARY PICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HIS
Contact information
Practice address
2472 BROADWAY, NORTH BEND, OR 97459
(541) 751-1117
(541) 751-1227
Mailing address
2472 BROADWAY, NORTH BEND, OR 97459
(541) 751-1117
(541) 751-1227
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ORHASP222289
OR
Other
Enumeration date
05/10/2010
Last updated
05/10/2010
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