Provider Demographics
NPI:1063410116
Name:BIERI, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 S DON ROSER DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9107
Mailing Address - Country:US
Mailing Address - Phone:575-522-7880
Mailing Address - Fax:575-522-7226
Practice Address - Street 1:2545 S DON ROSER DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9107
Practice Address - Country:US
Practice Address - Phone:575-522-7880
Practice Address - Fax:575-522-7226
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-07-02
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
NM98-13208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM94071861Medicaid
NMNM004961OtherBLUE CROSS BLUE SHIELD
NMNM00099Medicare PIN
NM94071861Medicaid
NMNM004961OtherBLUE CROSS BLUE SHIELD