Provider Demographics
NPI:1356393912
Name:PEARLSTINE, IRA S (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:S
Last Name:PEARLSTINE
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 1:561 NW LAKE WHITNEY PL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1624
Mailing Address - Country:US
Mailing Address - Phone:772-252-1425
Mailing Address - Fax:772-252-5917
Practice Address - Street 1:561 NW LAKE WHITNEY PL
Practice Address - Street 2:SUITE 104
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1624
Practice Address - Country:US
Practice Address - Phone:772-252-1425
Practice Address - Fax:772-252-5917
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 47037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ126AOtherMEDICARE GROUP
FLAJ126AOtherMEDICARE GROUP