Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016003699 | IL |
Y | 222Z00000X | Podiatrist | 016003699 | IL |
NPI | 1063420461 |
---|---|
Provider Name | Dr. William L. Pierce JR. |
First Address | Champaign, IL 61820-3909 |
Second Address | Champaign, IL 61822-3743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016003699 1 | (05) | IL |
480007534 | RAILROAD MEDICARE (01) | |
909010 | MEDICARE GROUP (01) |