Basic Information
Provider Information
NPI: 1215162607
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PIERCE
FirstName: JAMES
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9300 VALLEY CHILDRENS PL # SC05
Address2:  
City: MADERA
State: CA
PostalCode: 936368761
CountryCode: US
TelephoneNumber: 5593535700
FaxNumber: 5593535708
Practice Location
Address1: 9300 VALLEY CHILDRENS PL # GE01
Address2:  
City: MADERA
State: CA
PostalCode: 936368761
CountryCode: US
TelephoneNumber: 5593537290
FaxNumber: 5593537286
Other Information
ProviderEnumerationDate: 05/28/2009
LastUpdateDate: 03/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0120XA88011CAY Allopathic & Osteopathic PhysiciansSurgeryPediatric Surgery

No ID Information.


Home