Provider Demographics
NPI:1497838593
Name:PIERCE, WILLIAM JOHN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:PIERCE
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 1:210 E 90TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8102
Mailing Address - Country:US
Mailing Address - Phone:219-738-2008
Mailing Address - Fax:219-738-2127
Practice Address - Street 1:210 E 90TH DRIVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8102
Practice Address - Country:US
Practice Address - Phone:219-738-2008
Practice Address - Fax:219-738-2127
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN496530AMedicare PIN
E26970Medicare UPIN