Provider Demographics
NPI:1295775229
Name:PIERSON, BOBBY I (PA)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:I
Last Name:PIERSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST # MS 8321
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-8321
Mailing Address - Country:US
Mailing Address - Phone:806-743-3849
Mailing Address - Fax:806-743-5687
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:SUITE 3A105
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-8103
Practice Address - Country:US
Practice Address - Phone:806-743-2391
Practice Address - Fax:806-743-5687
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04240363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM202006417Medicaid
TX183145501Medicaid
OK200081390AMedicaid
NM202006417OtherPRESBYTERIAN COMMERCIAL
TX135127100OtherFIRSTCARE