Provider Demographics
NPI:1275621856
Name:PEIRCE, CHARLES KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KEVIN
Last Name:PEIRCE
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 1:3201 UNIVERSITY DR E
Mailing Address - Street 2:STE 440
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3486
Mailing Address - Country:US
Mailing Address - Phone:979-731-8660
Mailing Address - Fax:
Practice Address - Street 1:3201 UNIVERSITY DR E
Practice Address - Street 2:STE 370
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3475
Practice Address - Country:US
Practice Address - Phone:979-731-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5624208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AG630OtherBLUE CROSS BLUE SHIELD
TX126609006Medicaid
TX126609005Medicaid
TX00U13ROtherBLUE CROSS PROVIDER NUMBE
TX126609006Medicaid
TX8AG630OtherBLUE CROSS BLUE SHIELD
TX00U13RMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER