Provider Demographics
NPI:1043650682
Name:PEARSON, TUESDAY ELIZABETH (DO)
Entity Type:Individual
Prefix:MS
First Name:TUESDAY
Middle Name:ELIZABETH
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 NW IRVING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-274-5444
Mailing Address - Fax:503-274-5464
Practice Address - Street 1:2332 NW IRVING ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-274-5444
Practice Address - Fax:503-274-5444
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO162069207V00000X
WI61159207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology