Provider Demographics
NPI:1659345668
Name:PIERSON, JEROME (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:PIERSON
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:PO BOX 3128
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-3128
Mailing Address - Country:US
Mailing Address - Phone:712-239-4702
Mailing Address - Fax:712-239-0616
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:STE 410
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51102-1394
Practice Address - Country:US
Practice Address - Phone:712-239-4702
Practice Address - Fax:712-239-0616
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25565207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0080952Medicaid
IA0080952Medicaid
E52137Medicare UPIN