Provider Demographics
NPI:1154390359
Name:PIERCE, JEROME C (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:C
Last Name:PIERCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24221 CALLE DE LA LOUISA
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7638
Mailing Address - Country:US
Mailing Address - Phone:949-465-8155
Mailing Address - Fax:949-465-8159
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:SUITE 400
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-334-8200
Practice Address - Fax:949-465-8159
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG19506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A40670Medicare UPIN
CAWG19506CMedicare ID - Type Unspecified