Provider Demographics
NPI:1568432722
Name:PEARCE, BETH S (DPM)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:S
Last Name:PEARCE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE ORTHOPAEDIC PLACE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4202
Mailing Address - Country:US
Mailing Address - Phone:904-825-0540
Mailing Address - Fax:904-209-1055
Practice Address - Street 1:ONE ORTHOPAEDIC PLACE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4202
Practice Address - Country:US
Practice Address - Phone:904-825-0540
Practice Address - Fax:904-209-1055
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1513213EP1101X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174540001OtherDMERC
FL1174540001OtherDMERC CIGNA GOVT SVCS
FL87819YMedicare ID - Type Unspecified
FL1174540001OtherDMERC