Provider Demographics
NPI:1578532883
Name:PEARSON, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
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 1:200 EAST LEE STREET
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-2603
Mailing Address - Country:US
Mailing Address - Phone:928-289-3396
Mailing Address - Fax:928-289-2801
Practice Address - Street 1:200 EAST LEE STREET
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-2603
Practice Address - Country:US
Practice Address - Phone:928-289-3396
Practice Address - Fax:928-289-2801
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13986207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ271875Medicaid
AZ271875Medicaid
AZ29349Medicare ID - Type Unspecified