Provider Demographics
NPI:1659390086
Name:PEARL, ALLISON L (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:PEARL
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 1:5217 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4813
Mailing Address - Country:US
Mailing Address - Phone:801-313-4118
Mailing Address - Fax:
Practice Address - Street 1:5217 S STATE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4813
Practice Address - Country:US
Practice Address - Phone:801-313-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003013982085R0202X
CAA976512085R0202X
UT12649599-12052085R0202X
ORMD282622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A976510Medicaid
NC5902866Medicaid
OR023667Medicaid
NCI49665Medicare UPIN
CA00A976510Medicaid
OR023667Medicaid
NC5902866Medicaid
CAWA97651BMedicare PIN