Provider Demographics
NPI:1376700617
Name:PAUL C. PEARSON, DPM, PA
Entity Type:Organization
Organization Name:PAUL C. PEARSON, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-356-0151
Mailing Address - Street 1:7305 WALLACE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1815
Mailing Address - Country:US
Mailing Address - Phone:806-356-0151
Mailing Address - Fax:806-457-1656
Practice Address - Street 1:7305 WALLACE BLVD STE A
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1815
Practice Address - Country:US
Practice Address - Phone:806-356-0151
Practice Address - Fax:806-457-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1389213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092747701Medicaid
TX4746400001Medicare NSC
TX00954EMedicare PIN
TX00Z497Medicare PIN
TX8F8628Medicare PIN
TX092747701Medicaid
TX480030366Medicare PIN