Provider Demographics
NPI:1285623876
Name:PIERCE, CHRISTOPHER A (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W VERNEAL CT
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6535
Mailing Address - Country:US
Mailing Address - Phone:208-288-3298
Mailing Address - Fax:
Practice Address - Street 1:1512 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6008
Practice Address - Country:US
Practice Address - Phone:208-461-2883
Practice Address - Fax:208-461-2953
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0181207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID050060667OtherRAILROAD MEDICARE
ID804278000Medicaid
ID804278000Medicaid
ID1301548Medicare ID - Type Unspecified