Provider Demographics
NPI:1508377847
Name:PEARLMAN, MATTISON MCCRAY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MATTISON
Middle Name:MCCRAY
Last Name:PEARLMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 W CALLE MORADO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2523
Mailing Address - Country:US
Mailing Address - Phone:602-469-0781
Mailing Address - Fax:
Practice Address - Street 1:3250 W LOWER BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-6729
Practice Address - Country:US
Practice Address - Phone:602-876-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA60501363A00000X
AZ6829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant