Provider Demographics
NPI:1518919919
Name:PEARSON, BRUCE R (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 N WASHINGTON ST
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2908
Mailing Address - Country:US
Mailing Address - Phone:608-755-3500
Mailing Address - Fax:608-755-3500
Practice Address - Street 1:580 N WASHINGTON ST
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2908
Practice Address - Country:US
Practice Address - Phone:608-755-3500
Practice Address - Fax:608-755-3500
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19639-020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31178900Medicaid
WI1040OtherDEAN HEALTH INSURANCE
WIB55647Medicare UPIN