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NPI Code Detail

MEDICARE: DR. MILLARD LUCIEN TIERCE IV D.O.

MEDICARE: DR. MILLARD LUCIEN TIERCE IV D.O.
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
1207K00000XAllergy & Immunology PhysicianN8250TX

General Provider Information

NPI Number : 1528230687
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MILLARD LUCIEN TIERCE IV D.O.
Provider Business Mailing Address
First Line : 4200 S HULEN ST STE 230
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4924
Country : US
Telephone Number : 817-315-2550
Fax Number : 817-732-4660
Provider Business Practice Location Address
First Line : 4200 S HULEN ST STE 230
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4924
Country : US
Telephone Number : 817-315-2550
Fax Number : 817-732-4660
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2008
Last Update Date : 04/19/2022

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