Provider Demographics
NPI:1386758779
Name:PIERCE, SCOTT M (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3505 SHELBY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 E RALPH HALL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6878
Practice Address - Country:US
Practice Address - Phone:903-261-3303
Practice Address - Fax:469-533-9955
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1899207Q00000X, 208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020JTOtherBCBS
TX116512814Medicaid
TX116512810Medicaid
TX116512810Medicaid
TX8L25461Medicare PIN
TX116512814Medicaid