Provider Demographics
NPI:1417007162
Name:PIERRE, LLOYD ARTHUR JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:ARTHUR
Last Name:PIERRE
Suffix:JR
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 1:10506 BURT CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2094
Mailing Address - Country:US
Mailing Address - Phone:402-991-3393
Mailing Address - Fax:402-991-3390
Practice Address - Street 1:10506 BURT CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2094
Practice Address - Country:US
Practice Address - Phone:402-991-3393
Practice Address - Fax:402-991-3390
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24526207Q00000X
261QF0400X
IA37721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0188946Medicaid
1114906906OtherGRP NPI
161803OtherMEDICARE FQHC
49614OtherMEDICARE PART B