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General NPI Number Information
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NPI Number | 1982764684
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Entity Type | Organization
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Legal Business Name | BRUCE PIERSON JR MD PC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 600 18TH STREET SUITE 311
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City | PARKERSBURG
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State | WV
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Zip | 26101
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Country | US
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Telephone | 304-424-4640
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Fax | 304-424-4628
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Provider Business Mailing Address
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Address Line | 600 18TH STREET SUITE 311
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City | PARKERSBURG
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State | WV
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Zip | 26101
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Country | US
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Telephone | 304-424-4640
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Fax | 304-424-4628
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE H PIERSON JR.
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Credential | MD
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Telephone | 304-424-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 10635
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License Number State | WV
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