Provider Demographics
NPI:1629291836
Name:PIERCE, SURYA J (MD)
Entity Type:Individual
Prefix:
First Name:SURYA
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 1:425 AMHERST DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1308
Mailing Address - Country:US
Mailing Address - Phone:608-354-3534
Mailing Address - Fax:
Practice Address - Street 1:4700 JEFFERSON ST NE
Practice Address - Street 2:UNM CENTER FOR LIFE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2136
Practice Address - Country:US
Practice Address - Phone:505-925-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28688207Q00000X
WI53217207Q00000X
NMMD2015-0267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine