Healthcare Provider Details

I. General information

NPI: 1508858234
Provider Name (Legal Business Name): MARK N PIERSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N SUITE 140W
BILLINGS MT
59101-7506
US

IV. Provider business mailing address

2900 12TH AVE N SUITE 140W
BILLINGS MT
59101-7506
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-6540
  • Fax: 406-238-6599
Mailing address:
  • Phone: 406-238-6540
  • Fax: 406-238-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number414
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: