Provider Demographics
NPI:1821329129
Name:BIERER, ELIZABETH WILD (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WILD
Last Name:BIERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 S SUTTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-8054
Mailing Address - Country:US
Mailing Address - Phone:928-251-4244
Mailing Address - Fax:833-539-1739
Practice Address - Street 1:5300 S SUTTER DR STE A
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-8054
Practice Address - Country:US
Practice Address - Phone:928-251-4244
Practice Address - Fax:833-539-1739
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110169207Q00000X
AZ44328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ609503Medicaid