Provider Demographics
NPI:1366407215
Name:PIERCE, PAMELA D (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:D
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:929 N ST FRANCES
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5426
Practice Address - Fax:316-652-0340
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22997207ZP0102X
KS0422997207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100129950AMedicaid
KS220013641OtherRR MEDICARE
KS019845OtherBLUE CROSS/BLUE SHIELD OF KANSAS
E60062Medicare UPIN
KS100129950AMedicaid