Provider Demographics
NPI:1265438592
Name:PIERCE, S WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:S
Middle Name:WILLIAM
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 1:2645 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE. 120
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2898
Mailing Address - Country:US
Mailing Address - Phone:702-614-1800
Mailing Address - Fax:702-614-1888
Practice Address - Street 1:2645 W HORIZON RIDGE PKWY
Practice Address - Street 2:STE 120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2899
Practice Address - Country:US
Practice Address - Phone:702-614-1800
Practice Address - Fax:702-614-1888
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-03-28
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
NV09009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018616Medicaid
NV002018616Medicaid
NVV37631Medicare PIN