Provider Demographics
NPI:1922258714
Name:PEARSON, LARRY EUGENE I (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EUGENE
Last Name:PEARSON
Suffix:I
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 WHITMIRE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8775
Mailing Address - Country:US
Mailing Address - Phone:850-623-0830
Mailing Address - Fax:850-626-1862
Practice Address - Street 1:5020 WHITMIRE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8775
Practice Address - Country:US
Practice Address - Phone:850-623-0830
Practice Address - Fax:850-626-1862
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLICENSURE EXEMPT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility