Provider Demographics
NPI:1578586806
Name:PIERCE, JOHN J (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2002 N STOCKTON HILL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4698
Mailing Address - Country:US
Mailing Address - Phone:928-753-3303
Mailing Address - Fax:928-753-3603
Practice Address - Street 1:2002 N STOCKTON HILL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4698
Practice Address - Country:US
Practice Address - Phone:928-753-3303
Practice Address - Fax:928-753-3603
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4180207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12345Medicare UPIN