Healthcare Provider Details

I. General information

NPI: 1063410116
Provider Name (Legal Business Name): MARK BIERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

2545 S DON ROSER DR
LAS CRUCES NM
88011-9107
US

IV. Provider business mailing address

2545 S DON ROSER DR
LAS CRUCES NM
88011-9107
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-7880
  • Fax: 575-522-7226
Mailing address:
  • Phone: 575-522-7880
  • Fax: 575-522-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number98-13
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: