Provider Demographics
NPI:1649225921
Name:SOTER-PEARSALL, DESIREE A (MD)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:SOTER-PEARSALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MEMORIAL HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1786
Mailing Address - Country:US
Mailing Address - Phone:251-414-5900
Mailing Address - Fax:251-281-1169
Practice Address - Street 1:101 MEMORIAL HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1786
Practice Address - Country:US
Practice Address - Phone:251-414-5900
Practice Address - Fax:251-281-1198
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009927875Medicaid
AL110233518OtherRAILROAD MEDICARE PTAN
AL000029369Medicaid
AL04-10834OtherUNITED HEALTHCARE
AL51109805OtherBCBS
AL000029369Medicaid
AL04-10834OtherUNITED HEALTHCARE