Provider Demographics
NPI:1538165329
Name:PIERSON, DENNIS J (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:PIERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1220 E ELM ST
Mailing Address - Street 2:STE 240
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2898
Mailing Address - Country:US
Mailing Address - Phone:419-227-9676
Mailing Address - Fax:419-227-9794
Practice Address - Street 1:1220 E ELM ST
Practice Address - Street 2:STE 240
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2898
Practice Address - Country:US
Practice Address - Phone:419-227-9676
Practice Address - Fax:419-227-9794
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-043987P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000029652OtherANTHEM BCBS
OH341834728027OtherCARESOURCE
OH000000031107OtherANTHEM BCBS
OH0483267Medicaid
OH4354207OtherAETNA HMO
OH080149193OtherRAILROAD MEDICARE
OH03944OtherPARAMOUNT
OH735029OtherBUCKEYE COMMUNITY HEALTH
OH0919474OtherAETNA
OH4354207OtherAETNA HMO
OH0483354Medicare ID - Type Unspecified