Provider Demographics
NPI:1407888613
Name:PIERCE, JOHN RUSH JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RUSH
Last Name:PIERCE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-2147
Practice Address - Fax:505-272-9437
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-06-19
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Provider Licenses
StateLicense IDTaxonomies
TXF9108207R00000X
NM81-286207R00000X, 207RG0300X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100152140AMedicaid
TX128961309Medicaid
NMF7736Medicaid
NMF7736Medicaid
OK100152140AMedicaid