MEDICARE: DR. STEPHANIE LYNN GROSS PIERCE M.D.

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
1	207Q00000X	Family Medicine Physician	J4173	TX

General Provider Information

NPI Number	:	1912085051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE LYNN GROSS PIERCE M.D.

Provider Business Mailing Address
First Line	:	1850 W LAKE HOUSTON PKWY
Second Line	:	STE 190
City	:	KINGWOOD
State	:	TX
Zip	:	77339-5237
Country	:	US
Telephone Number	:	281-361-2902
Fax Number	:	281-361-5792

Provider Business Practice Location Address
First Line	:	1850 W LAKE HOUSTON PKWY
Second Line	:	STE. 190
City	:	KINGWOOD
State	:	TX
Zip	:	77339-5237
Country	:	US
Telephone Number	:	281-361-2902
Fax Number	:	281-361-5792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	11/05/2012

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