Provider Demographics
NPI:1013312024
Name:HARVEY A PEARL DPM PA
Entity Type:Organization
Organization Name:HARVEY A PEARL DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PA
Authorized Official - Phone:904-737-4166
Mailing Address - Street 1:2324 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2021
Mailing Address - Country:US
Mailing Address - Phone:904-737-4166
Mailing Address - Fax:904-737-4322
Practice Address - Street 1:2324 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2021
Practice Address - Country:US
Practice Address - Phone:904-737-4166
Practice Address - Fax:904-737-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041275900Medicaid
FL041275900Medicaid