Provider Demographics
NPI:1881700581
Name:PIERCE, SAMUEL J (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:PIERCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8601 VILLAGE DRIVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5509
Mailing Address - Country:US
Mailing Address - Phone:210-656-3533
Mailing Address - Fax:210-656-4493
Practice Address - Street 1:1503 SW LOOP 410
Practice Address - Street 2:SUITE 113
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1681
Practice Address - Country:US
Practice Address - Phone:210-656-3533
Practice Address - Fax:210-656-4493
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2012-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH9473207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118471504Medicaid
8B8843Medicare ID - Type Unspecified
G87460Medicare UPIN