Provider Demographics
NPI:1184629347
Name:PEARSE, LEE ANN (MD)
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:PEARSE
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 1:7777 FOREST LN
Mailing Address - Street 2:STE B141
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2527
Mailing Address - Country:US
Mailing Address - Phone:972-566-5622
Mailing Address - Fax:972-566-5616
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:STE B141
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2527
Practice Address - Country:US
Practice Address - Phone:972-566-5622
Practice Address - Fax:972-566-5616
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK45242080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1297350-06Medicaid
TX1297350-06Medicaid
TX00905WMedicare ID - Type UnspecifiedMEDICARE INDV #