Provider Demographics
NPI:1437809563
Name:PEARL, THEA DAVIES (MD)
Entity Type:Individual
Prefix:DR
First Name:THEA
Middle Name:DAVIES
Last Name:PEARL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THEA
Other - Middle Name:KAY
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3745 E TURNEY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4011
Mailing Address - Country:US
Mailing Address - Phone:602-206-1168
Mailing Address - Fax:
Practice Address - Street 1:3745 E TURNEY AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4011
Practice Address - Country:US
Practice Address - Phone:602-206-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine