Provider Demographics
NPI:1710214408
Name:PEAR TREE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PEAR TREE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:JEFFRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-412-6700
Mailing Address - Street 1:PO BOX 84170
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0017
Mailing Address - Country:US
Mailing Address - Phone:281-412-6700
Mailing Address - Fax:281-412-6701
Practice Address - Street 1:6302 BROADWAY ST
Practice Address - Street 2:SUITE 130
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7856
Practice Address - Country:US
Practice Address - Phone:281-412-6700
Practice Address - Fax:281-412-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0320207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A5551Medicare PIN