Basic Information
| Provider Information | |||||||||
| NPI: | 1003961319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCEFIELD | ||||||||
| FirstName: | DAYNE | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8963 ALDERWOOD WAY | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361170900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786446798 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12902 USF MAGNOLIA DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336129416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886633488 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA08984100 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 42389 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME61640 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 42389 | 01 | GA | GEORGIA BOARD OF MEDICINE | OTHER | ME61640 | 01 | FL | FLORIDA BOARD OF MEDICINE | OTHER | 25MA08984100 | 01 | NJ | NJ LICENSE | OTHER | D09905800 | 01 | NJ | NJ CDS REGISTRATION | OTHER |