Provider Demographics
NPI:1174511067
Name:PIERCE, RANDALL ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:ALLAN
Last Name:PIERCE
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 1:4877 RAMCREEK TRL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-8028
Mailing Address - Country:US
Mailing Address - Phone:775-224-5880
Mailing Address - Fax:775-825-6090
Practice Address - Street 1:2375 E. PRATER WAY
Practice Address - Street 2:SPARKS RADIOLOGY
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434
Practice Address - Country:US
Practice Address - Phone:775-331-7000
Practice Address - Fax:775-825-6090
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV92132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500052Medicaid
NVE86214Medicare UPIN
NV36986Medicare ID - Type Unspecified36909
NV36984Medicare ID - Type Unspecified36907
NV36985Medicare ID - Type Unspecified36908
NV37641Medicare ID - Type UnspecifiedNNMC