MEDICARE: PIERCE MOBILE MEDICINE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	01064273A	IN

General Provider Information

NPI Number	:	1437582384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIERCE MOBILE MEDICINE, PC

Provider Business Mailing Address
First Line	:	1300 E 86TH ST
Second Line	:	SUITE 14 126
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1997
Country	:	US
Telephone Number	:	317-288-9385
Fax Number	:	317-288-9386

Provider Business Practice Location Address
First Line	:	1300 E 86TH ST
Second Line	:	SUITE 14 126
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1997
Country	:	US
Telephone Number	:	317-288-9385
Fax Number	:	317-288-9386

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DUAN L PIERCE
Credential	:	M.D.
Telephone Number	:	317-288-9385

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	09/15/2013

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