Provider Demographics
NPI:1245289511
Name:PEARSON, SUSAN M (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1240 COLLEGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2288
Mailing Address - Country:US
Mailing Address - Phone:307-856-1206
Mailing Address - Fax:307-856-6056
Practice Address - Street 1:1240 COLLEGE VIEW DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2288
Practice Address - Country:US
Practice Address - Phone:307-856-1206
Practice Address - Fax:307-856-6056
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY4685A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117956000Medicaid
WY311702OtherBLUE CROSS BLUE SHIELD
WY311702OtherBLUE CROSS BLUE SHIELD
WYE58120Medicare UPIN