Provider Demographics
NPI:1033221262
Name:PEARSON, JOHN D (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-4605
Mailing Address - Country:US
Mailing Address - Phone:530-528-8600
Mailing Address - Fax:530-246-0644
Practice Address - Street 1:2111 AIRPARK DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2433
Practice Address - Country:US
Practice Address - Phone:530-247-3733
Practice Address - Fax:530-246-0644
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10506207QA0401X, 208VP0000X
CAPA14973207QA0401X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA149730OtherTRICARE
CAOPA149733OtherMEDICARE
CAOPA149733OtherMEDICARE
P13549Medicare UPIN