Provider Demographics
NPI:1063594091
Name:PIERSON, ROY S (MD00044568)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:S
Last Name:PIERSON
Suffix:
Gender:M
Credentials:MD00044568
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3003 TIETON DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3679
Mailing Address - Country:US
Mailing Address - Phone:509-895-7900
Mailing Address - Fax:
Practice Address - Street 1:1211 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1347
Practice Address - Country:US
Practice Address - Phone:509-454-8888
Practice Address - Fax:509-453-0061
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044568207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2091673Medicaid