Basic Information
| Provider Information | |||||||||
| NPI: | 1376527192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERSON | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12188B N MERIDIAN ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460324840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177062361 | ||||||||
| FaxNumber: | 3177062362 | ||||||||
| Practice Location | |||||||||
| Address1: | 12188B N MERIDIAN ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460324840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177062361 | ||||||||
| FaxNumber: | 3177062362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 10/09/2013 | ||||||||
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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 | 207X00000X | 01039944 | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200042105 | 01 | IN | RR MEDICARE | OTHER | 2000383002 | 01 | IN | CIGNA | OTHER | 4251092 | 01 | IN | AETNA | OTHER | 014532 | 01 | IN | SIHO | OTHER | 1081975 | 01 | IN | UHC | OTHER | 000000207867 | 01 | IN | BCBS | OTHER |