Healthcare Provider Details

I. General information

NPI: 1073593802
Provider Name (Legal Business Name): DAVID PIERCE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 TENNESSEE AVE
LYNN HAVEN FL
32444-3653
US

IV. Provider business mailing address

PO BOX 99
SOPCHOPPY FL
32358-0099
US

V. Phone/Fax

Practice location:
  • Phone: 850-265-3606
  • Fax:
Mailing address:
  • Phone: 850-528-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0007653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: