Provider Demographics
NPI:1053515379
Name:DOUGLAS K PIERCE MD PA
Entity type:Organization
Organization Name:DOUGLAS K PIERCE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KIMBALL
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-393-4900
Mailing Address - Street 1:8787 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1251
Mailing Address - Country:US
Mailing Address - Phone:727-393-4900
Mailing Address - Fax:727-393-4910
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 360
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1251
Practice Address - Country:US
Practice Address - Phone:727-393-4900
Practice Address - Fax:727-393-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1164Medicare ID - Type UnspecifiedGROUP NUMBER