Provider Demographics
NPI:1861484677
Name:PIERSON, JOHN DUANE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DUANE
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 1:555 S DUNCAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-6255
Mailing Address - Country:US
Mailing Address - Phone:727-303-3995
Mailing Address - Fax:727-242-2335
Practice Address - Street 1:555 S DUNCAN AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-303-3995
Practice Address - Fax:727-242-2335
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136TYMedicaid
NC89136TYMedicaid