1174511067 NPI number — RANDALL ALLAN PIERCE MD

Table of content: RANDALL ALLAN PIERCE MD (NPI 1174511067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174511067 NPI number — RANDALL ALLAN PIERCE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERCE
Provider First Name:
RANDALL
Provider Middle Name:
ALLAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174511067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4877 RAMCREEK TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89519-8028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-224-5880
Provider Business Mailing Address Fax Number:
775-825-6090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2375 E. PRATER WAY
Provider Second Line Business Practice Location Address:
SPARKS RADIOLOGY
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-331-7000
Provider Business Practice Location Address Fax Number:
775-825-6090
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  9213 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100500052 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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