Provider Demographics
NPI:1851574362
Name:PEARSON, GLEN T (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:T
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3303 LEE PKWY
Mailing Address - Street 2:220
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5108
Mailing Address - Country:US
Mailing Address - Phone:214-522-5120
Mailing Address - Fax:214-522-5488
Practice Address - Street 1:3303 LEE PKWY
Practice Address - Street 2:220
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5108
Practice Address - Country:US
Practice Address - Phone:214-522-5120
Practice Address - Fax:214-522-5488
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD85942084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry