Provider Demographics
NPI:1922000504
Name:PEARCE, STEPHEN MOE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MOE
Last Name:PEARCE
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 1:1015 EAST 32ND ST
Mailing Address - Street 2:101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-477-6341
Mailing Address - Fax:512-477-1148
Practice Address - Street 1:1015 EAST 32ND ST
Practice Address - Street 2:101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-477-6341
Practice Address - Fax:512-477-1148
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4360207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128667604Medicaid
TX804434Medicare PIN
TX0349690003Medicare NSC
TX010020569Medicare PIN
TX128667604Medicaid
TX0349690001Medicare NSC
TXCS4290Medicare PIN