Provider Demographics
NPI:1649229154
Name:PEARSON, EARL STANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:STANTON
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:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258
Mailing Address - Country:US
Mailing Address - Phone:559-781-1812
Mailing Address - Fax:559-781-3855
Practice Address - Street 1:573 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:559-781-1812
Practice Address - Fax:559-781-3855
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41796207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G417960Medicaid
A48694Medicare UPIN
CA00G417960Medicare ID - Type Unspecified