Provider Demographics
NPI:1053361154
Name:HERARD, PIERRE R (MD)
Entity type:Individual
Prefix:
First Name:PIERRE
Middle Name:R
Last Name:HERARD
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-7110
Mailing Address - Fax:239-343-5255
Practice Address - Street 1:16281 BASS RD STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9687
Practice Address - Country:US
Practice Address - Phone:239-343-7110
Practice Address - Fax:239-343-5255
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201050208VP0014X, 2081P2900X
FLME140504208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01826815Medicaid
FL105455800Medicaid
NYRA2793Medicare PIN