Basic Information
| Provider Information | |||||||||
| NPI: | 1124086715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIERMAN | ||||||||
| FirstName: | SOLOMON | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4777 US HIGHWAY 259 | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756057668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002144906 | ||||||||
| FaxNumber: | 9036639960 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 EAST I-30 | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726983000 | ||||||||
| FaxNumber: | 9726982030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 11/18/2011 | ||||||||
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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 | 2085R0202X | H9017 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 119242901 | 05 | TX | MEDICAID |