Healthcare Provider Details

I. General information

NPI: 1417054792
Provider Name (Legal Business Name): MARK BIERI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE SUITE 405
LAS CRUCES NM
88011-8259
US

IV. Provider business mailing address

4351 E LOHMAN AVE SUITE 405
LAS CRUCES NM
88011-8259
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-0121
  • Fax: 575-532-5949
Mailing address:
  • Phone: 575-521-0121
  • Fax: 575-532-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK BIERI
Title or Position: PRESIDENT
Credential: MD
Phone: 575-521-0121