Provider Demographics
NPI:1053408724
Name:PIERCE, DAVID ALBERT (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALBERT
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 1:421 SW OAK ST
Mailing Address - Street 2:STE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1842
Mailing Address - Country:US
Mailing Address - Phone:503-646-0161
Mailing Address - Fax:503-221-4451
Practice Address - Street 1:15950 SW MILLIKAN WAY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-646-0161
Practice Address - Fax:503-221-4451
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288320Medicaid
B97609Medicare UPIN
112482Medicare ID - Type Unspecified