Provider Demographics
NPI:1699034900
Name:PIERSON, GRANT TYLER (DO)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:TYLER
Last Name:PIERSON
Suffix:
Gender:M
Credentials:DO
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-4662
Mailing Address - Fax:
Practice Address - Street 1:1002 MCINTOSH CIR STE 4
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-347-8315
Practice Address - Fax:417-347-8317
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015044739207RC0200X, 207RS0012X, 207RP1001X, 207RP1001X, 207RS0012X
KS05-40714207RS0012X, 207RC0200X, 207RP1001X, 207RS0012X
CODR.0055410207RS0012X, 207RS0012X
OH34.011461207RS0012X, 207RS0012X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease