Basic Information
| Provider Information | |||||||||
| NPI: | 1083670095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2106 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725600510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702625056 | ||||||||
| FaxNumber: | 8702693093 | ||||||||
| Practice Location | |||||||||
| Address1: | 2106 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725600510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702625056 | ||||||||
| FaxNumber: | 8702693093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | E3494 | AR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 148557001 | 05 | AR | MEDICAID |