Provider Demographics
NPI:1912971268
Name:PIERCE, ALAN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:DAVID
Last Name:PIERCE
Suffix:
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 1:2030 W MCNAB RD
Mailing Address - Street 2:STE 2
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1002
Mailing Address - Country:US
Mailing Address - Phone:954-633-1010
Mailing Address - Fax:954-633-1024
Practice Address - Street 1:10101 FOREST HILL BLVD
Practice Address - Street 2:WELLINGTON REG MED CENTER PATHOLOGY DEPT
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6103
Practice Address - Country:US
Practice Address - Phone:561-798-8568
Practice Address - Fax:561-798-8645
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044801207ZP0102X
SCMD9166207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069872500Medicaid
SCMD9166OtherMEDICAL LICENSE
FLME44801OtherMEDICAL LICENSE
SC009166Medicaid
FL96514YMedicare PIN
FL069872500Medicaid
FLD64899Medicare UPIN