Provider Demographics
NPI:1790752368
Name:PIERCY, JONATHAN (MD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:PIERCY
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 1988
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702
Mailing Address - Country:US
Mailing Address - Phone:606-439-1300
Mailing Address - Fax:606-439-1400
Practice Address - Street 1:145 CITIZENS LANE
Practice Address - Street 2:STE B PRIMARY CARE CENTERS OF EASTERN KENTUCKY
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-439-1300
Practice Address - Fax:606-439-1400
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64101587Medicaid
KY64101587Medicaid
KY0984409Medicare PIN
KY183942Medicare Oscar/Certification
KY183918Medicare Oscar/Certification
KY0776312Medicare PIN
KY183947Medicare Oscar/Certification