Provider Demographics
NPI:1477594828
Name:PIERCE, THERMAN DANE JR (MD)
Entity type:Individual
Prefix:
First Name:THERMAN
Middle Name:DANE
Last Name:PIERCE
Suffix:JR
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:684-797-6044
Mailing Address - Fax:
Practice Address - Street 1:890 S PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2455
Practice Address - Country:US
Practice Address - Phone:864-271-1450
Practice Address - Fax:864-271-3914
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC7855208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4556604OtherAETNA ID
SC571004971003OtherBCBS OF SC ID
SC078551Medicaid
SC1581664OtherCIGNA ID
SC1581664OtherCIGNA ID