Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD20983 | TN |
NPI | 1053388561 |
---|---|
Provider Name | Mark Arden Pierce |
First Address | Cookeville, TN 38501-2435 |
Second Address | Cookeville, TN 38501-2447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 15/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1509191 | (05) | TN |
4352435 | BCBS (01) | TN |
64799091 | (05) | KY |
C73895 | (02) | TN |