Provider Demographics
NPI:1760242101
Name:PEARSON, MICHAEL A SR
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:PEARSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 STOCKARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2051
Mailing Address - Country:US
Mailing Address - Phone:314-326-7725
Mailing Address - Fax:
Practice Address - Street 1:2612 WYOMING ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-2402
Practice Address - Country:US
Practice Address - Phone:314-588-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist