Provider Demographics
NPI:1649231903
Name:PEARSON, HAROLD WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:WILLIAM
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HAROLD
Other - Middle Name:WILLIAM
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1564 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4511
Mailing Address - Country:US
Mailing Address - Phone:800-636-1701
Mailing Address - Fax:866-693-7090
Practice Address - Street 1:1564 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4511
Practice Address - Country:US
Practice Address - Phone:800-636-1701
Practice Address - Fax:866-693-7090
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15694R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME93259OtherMEDICAL LICENSE
LA1463264Medicaid
LA1463264Medicaid
FLME93259OtherMEDICAL LICENSE