Provider Demographics
NPI:1568488575
Name:PIERCE, EDDIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:J
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 1:727 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-1705
Mailing Address - Country:US
Mailing Address - Phone:308-832-3400
Mailing Address - Fax:308-832-3417
Practice Address - Street 1:727 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1705
Practice Address - Country:US
Practice Address - Phone:308-832-3400
Practice Address - Fax:308-832-3417
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE04376OtherBLUE CROSS BLUE SHIELD
NEAO2755Medicare UPIN
NE04376OtherBLUE CROSS BLUE SHIELD