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NPI Code Detail

MEDICARE: STEPHEN PIERCE

MEDICARE: STEPHEN PIERCE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerST2979TX

General Provider Information

NPI Number : 1174930564
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN PIERCE
Provider Business Mailing Address
First Line : 4550 GLADIOLA LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-1833
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4550 GLADIOLA LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-1833
Country : US
Telephone Number : 817-763-0307
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2014
Last Update Date : 07/17/2014

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