Provider Demographics
NPI:1972085579
Name:PEARSON, WILLIAM BRIAN (CAPS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRIAN
Last Name:PEARSON
Suffix:
Gender:M
Credentials:CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 W 450 N
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-9729
Mailing Address - Country:US
Mailing Address - Phone:765-661-2630
Mailing Address - Fax:
Practice Address - Street 1:687 W 450 N
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-9729
Practice Address - Country:US
Practice Address - Phone:765-661-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN928155171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications