Provider Demographics
NPI:1528194453
Name:PIERCE, DOUGLAS KIMBALL (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:KIMBALL
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 1:8787 BRYAN DAIRY RD
Mailing Address - Street 2:#360
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1260
Mailing Address - Country:US
Mailing Address - Phone:727-393-4900
Mailing Address - Fax:727-393-4910
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:#360
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1251
Practice Address - Country:US
Practice Address - Phone:727-393-4900
Practice Address - Fax:727-393-4910
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL0051303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048485701Medicaid
FL048485701Medicaid
FL68465Medicare PIN