Provider Demographics
NPI:1154385532
Name:PIERCE, STEPHEN A (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:PIERCE
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 1:2901 VIA FORTUNA
Mailing Address - Street 2:SUITE 600
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7565
Mailing Address - Country:US
Mailing Address - Phone:512-402-6233
Mailing Address - Fax:512-831-4170
Practice Address - Street 1:14904 CORDERO DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4533
Practice Address - Country:US
Practice Address - Phone:512-400-5211
Practice Address - Fax:512-761-3501
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7481207R00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097944503Medicaid
TX097944503Medicaid
TX8509K2Medicare ID - Type Unspecified