Provider Demographics
NPI:1972681831
Name:PIERCE, EDWARD LEWIS (MD PC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEWIS
Last Name:PIERCE
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 14TH AVE SW
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270
Mailing Address - Country:US
Mailing Address - Phone:406-488-2231
Mailing Address - Fax:406-488-2520
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:SUITE 112
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270
Practice Address - Country:US
Practice Address - Phone:406-488-2231
Practice Address - Fax:406-488-2520
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0064584Medicaid
000009433Medicare ID - Type Unspecified
MT0064584Medicaid