Provider Demographics
NPI:1417959206
Name:PEARL, JAMES E (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:PEARL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:324 10TH AVE
Mailing Address - Street 2:STE 170
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2853
Mailing Address - Country:US
Mailing Address - Phone:801-322-1000
Mailing Address - Fax:801-408-5556
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:STE 170
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-322-1000
Practice Address - Fax:801-408-5556
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT76-159612-1205207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3046OtherPEHP
870371439OtherP5 HEALTH SERVICE
NV000371439Medicaid
WY107990500Medicaid
870371439OtherMOLINA
870371439001OtherMBA
ID003011000Medicaid
107005238103OtherIHC
35993OtherDMBA
48844901OtherFIRST HEALTH
ID000010006858OtherRGENCE BLUE SHIELD
31053OtherSTATE FARM
48-00035OtherUHC
870371439OtherAETNA
8703714390001OtherCIGNA
48844901OtherFIRST HEALTH
48-00035OtherUHC
ID003011000Medicaid