Provider Demographics
NPI:1417054792
Name:MARK BIERI MD PC
Entity Type:Organization
Organization Name:MARK BIERI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-521-0121
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:575-521-0121
Mailing Address - Fax:575-532-5949
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-521-0121
Practice Address - Fax:575-532-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS5777Medicaid