Provider Demographics
NPI:1376548552
Name:PEARL, HARVEY A (DPM, PA)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:A
Last Name:PEARL
Suffix:
Gender:M
Credentials:DPM, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2021
Mailing Address - Country:US
Mailing Address - Phone:904-737-4166
Mailing Address - Fax:904-737-4322
Practice Address - Street 1:2324 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2021
Practice Address - Country:US
Practice Address - Phone:904-737-4166
Practice Address - Fax:904-737-4322
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO526213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041275900Medicaid
FL87227ZMedicare PIN