Provider Demographics
NPI:1528377165
Name:PEARSON, JEFFREY A
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:PEARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 486 BOX 48
Mailing Address - Street 2:
Mailing Address - City:OKINAWA
Mailing Address - State:JAPAN
Mailing Address - Zip Code:96362
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 482
Practice Address - Street 2:
Practice Address - City:OKINAWA
Practice Address - State:JAPAN
Practice Address - Zip Code:96362
Practice Address - Country:JP
Practice Address - Phone:315-646-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant