Provider Demographics
NPI:1073593802
Name:PIERCE, DAVID (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:SOPCHOPPY
Mailing Address - State:FL
Mailing Address - Zip Code:32358-0099
Mailing Address - Country:US
Mailing Address - Phone:850-528-1650
Mailing Address - Fax:
Practice Address - Street 1:1606 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3653
Practice Address - Country:US
Practice Address - Phone:850-265-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0007653207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA089145291BMedicaid
FL272034500Medicaid
FL35719OtherBCBS
FL35719OtherBCBS
FLG18829Medicare UPIN
P00408459Medicare PIN
GA089145291BMedicaid