Provider Demographics
NPI:1275602195
Name:PIERCE, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:PIERCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3318
Mailing Address - Country:US
Mailing Address - Phone:573-778-4729
Mailing Address - Fax:573-778-4731
Practice Address - Street 1:1500 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3318
Practice Address - Country:US
Practice Address - Phone:573-778-4729
Practice Address - Fax:573-778-4731
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7H74207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO718000034Medicare Oscar/Certification
MOF02376Medicare UPIN
F02376Medicare UPIN