Provider Demographics
NPI:1144205501
Name:PEARCE, RALPH PURCELL (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:PURCELL
Last Name:PEARCE
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 1:129 VISION PARK BLVD
Mailing Address - Street 2:# 307
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3023
Mailing Address - Country:US
Mailing Address - Phone:936-321-5440
Mailing Address - Fax:936-271-3705
Practice Address - Street 1:129 VISION PARK BLVD
Practice Address - Street 2:# 307
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3023
Practice Address - Country:US
Practice Address - Phone:936-321-5440
Practice Address - Fax:936-271-3705
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4376174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00EQ60OtherBCBS
TX098185403Medicaid
TX100016534OtherRAILROAD MEDICARE
TX098185403Medicaid
TXC20347Medicare UPIN