Provider Demographics
NPI:1295753564
Name:PIERCE, MARK EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:PIERCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1093 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3811
Mailing Address - Country:US
Mailing Address - Phone:530-221-1565
Mailing Address - Fax:530-221-3912
Practice Address - Street 1:1093 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3811
Practice Address - Country:US
Practice Address - Phone:530-221-1565
Practice Address - Fax:539-221-3912
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48872Medicare UPIN
CA00G422363Medicare ID - Type UnspecifiedHTMC (REDDING PRIMARY CAR
CA00G422362Medicare ID - Type UnspecifiedCORPORATION BILLING NO