Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 5101010952 | MI |
NPI | 1235103771 |
---|---|
Provider Name | Jeff Scott Pierce |
First Address | Orchard Lake, MI 48324-2965 |
Second Address | Troy, MI 48083-2015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 04/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G14665 | (02) | MI |