Provider Demographics
NPI:1437582384
Name:PIERCE MOBILE MEDICINE, PC
Entity Type:Organization
Organization Name:PIERCE MOBILE MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-288-9385
Mailing Address - Street 1:1300 E 86TH ST
Mailing Address - Street 2:SUITE 14 126
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1997
Mailing Address - Country:US
Mailing Address - Phone:317-288-9385
Mailing Address - Fax:317-288-9386
Practice Address - Street 1:1300 E 86TH ST
Practice Address - Street 2:SUITE 14 126
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1997
Practice Address - Country:US
Practice Address - Phone:317-288-9385
Practice Address - Fax:317-288-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064273A207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty