Provider Demographics
NPI:1588835227
Name:PEARCE, JAY (DO)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:PEARCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LAGUNA VISTA
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:TX
Mailing Address - Zip Code:78358
Mailing Address - Country:US
Mailing Address - Phone:361-729-9313
Mailing Address - Fax:
Practice Address - Street 1:8 LAGUNA VISTA
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:TX
Practice Address - Zip Code:78358
Practice Address - Country:US
Practice Address - Phone:361-729-9313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4608208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD87470Medicare UPIN