Individual
CHARLES CROWELL PIERCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
619 S FLEISHEL AVE STE 305, TYLER, TX 75701-2004
(903) 606-1173
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05595
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214077401
—
TX
01
—
75-2616977-095
TRICARE
TX
01
—
752616977-103
TRICARE
TX
01
—
752616977006
TRICARE
TX
01
—
824N49
BCBS
TX
Enumeration date
04/22/2006
Last updated
01/29/2025
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