Provider Demographics
NPI:1922086453
Name:PIERCE, JERRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:D
Last Name:PIERCE
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 1:408 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2424
Mailing Address - Country:US
Mailing Address - Phone:256-259-5211
Mailing Address - Fax:256-259-6641
Practice Address - Street 1:408 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2424
Practice Address - Country:US
Practice Address - Phone:256-259-5211
Practice Address - Fax:256-259-6641
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13423207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009965350Medicaid
ALC74954Medicare UPIN
AL051551097Medicare ID - Type Unspecified