MEDICARE: DR. JOHN EDWARD PIERCE M.D.

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	207Q00000X	Family Medicine Physician	35057334	OH

General Provider Information

NPI Number	:	1598755712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EDWARD PIERCE M.D.

Provider Business Mailing Address
First Line	:	28555 STARBRIGHT BLVD
Second Line	:	SUITE B
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-5662
Country	:	US
Telephone Number	:	419-931-3030
Fax Number	:	419-931-3046

Provider Business Practice Location Address
First Line	:	28555 STARBRIGHT BLVD
Second Line	:	SUITE B
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-5662
Country	:	US
Telephone Number	:	419-931-3030
Fax Number	:	419-931-3046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	06/30/2011

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