Provider Demographics
NPI:1457376790
Name:PIERSON, JOSEPH EMANUEL III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EMANUEL
Last Name:PIERSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 N PRAIRIE AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4509
Mailing Address - Country:US
Mailing Address - Phone:323-944-0949
Mailing Address - Fax:323-782-0388
Practice Address - Street 1:301 N PRAIRIE AVE STE 230
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4509
Practice Address - Country:US
Practice Address - Phone:323-944-0949
Practice Address - Fax:323-782-0388
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53815207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0063270Medicaid
CAGR0063272Medicaid
CAGR0063270Medicaid
CAW13240Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAW13240BMedicare ID - Type UnspecifiedPROVIDER NUMBER