Provider Demographics
NPI:1285689729
Name:PIERPONT, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:PIERPONT
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:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:
Practice Address - Street 1:1631 W INA RD STE 151
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1907
Practice Address - Country:US
Practice Address - Phone:520-825-4711
Practice Address - Fax:520-825-4712
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL09052084N0400X
AZ240672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ713512Medicaid
AZ67518Medicare ID - Type Unspecified
AZ713512Medicaid