Provider Demographics
NPI:1619189388
Name:BERNARD PEARL, DEIRDRE (MD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:BERNARD PEARL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:
Other - Last Name:PEARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:962 SEBASTOPOL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-6829
Mailing Address - Country:US
Mailing Address - Phone:707-578-2005
Mailing Address - Fax:707-578-8037
Practice Address - Street 1:962 SEBASTOPOL RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-6829
Practice Address - Country:US
Practice Address - Phone:707-578-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA562012080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine