Healthcare Provider Details

I. General information

NPI: 1225106925
Provider Name (Legal Business Name): WILLIAM ROBERT PIERCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 S 10TH ST
CANON CITY CO
81212-4920
US

IV. Provider business mailing address

626 S 10TH ST
CANON CITY CO
81212-4920
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-6961
  • Fax: 719-275-6961
Mailing address:
  • Phone: 719-275-6961
  • Fax: 719-275-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: