Provider Demographics
NPI:1639483068
Name:JACK PIERCE,MD PLLC
Entity Type:Organization
Organization Name:JACK PIERCE,MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:W
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-415-1649
Mailing Address - Street 1:PO BOX 26810
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0810
Mailing Address - Country:US
Mailing Address - Phone:512-415-1649
Mailing Address - Fax:512-291-3556
Practice Address - Street 1:6818 AUSTIN CENTER BLVD
Practice Address - Street 2:STE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3158
Practice Address - Country:US
Practice Address - Phone:512-415-1649
Practice Address - Fax:512-291-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB107032Medicare PIN