Provider Demographics
NPI:1801836846
Name:PIERCE, RAYMOND L (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
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 1:101 E MINNESOTA ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7756
Mailing Address - Country:US
Mailing Address - Phone:605-718-7450
Mailing Address - Fax:605-718-7465
Practice Address - Street 1:101 E MINNESOTA ST
Practice Address - Street 2:SUITE 260
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7756
Practice Address - Country:US
Practice Address - Phone:605-718-7450
Practice Address - Fax:605-718-7465
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0040213OtherBLUE SHIELD
SD6004290Medicaid
SD0040213OtherBLUE SHIELD
SD6004290Medicaid