Provider Demographics
NPI:1265537195
Name:PEARSON, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 E 2700 S
Mailing Address - Street 2:APT. 7
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3142
Mailing Address - Country:US
Mailing Address - Phone:385-228-7047
Mailing Address - Fax:
Practice Address - Street 1:10011 S CENTENNIAL PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4156
Practice Address - Country:US
Practice Address - Phone:801-566-5350
Practice Address - Fax:801-890-0706
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT267417-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTPRA06154OtherMOLINA
UT264723OtherDESERET MUTUAL
UT607111900OtherUS DEPT OF LABOR
UT224510OtherALTIUS
UT81624OtherPEHP
UT107004712102OtherIHC
UT45005OtherHEALTHY U
UT224510OtherALTIUS
UT607111900OtherUS DEPT OF LABOR
UT005784203Medicare ID - Type Unspecified