Provider Demographics
NPI:1053945279
Name:PIERRE, JIMMY (MD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:PIERRE
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 1:2074 MIDYETTE RD APT 1014
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-6248
Mailing Address - Country:US
Mailing Address - Phone:305-928-9616
Mailing Address - Fax:
Practice Address - Street 1:2634 CAPITAL CIR NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4106
Practice Address - Country:US
Practice Address - Phone:850-523-3261
Practice Address - Fax:850-523-3411
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE29878208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice