Provider Demographics
NPI:1780739482
Name:PEARSON FACIAL PLASTIC SURGERY PA
Entity type:Organization
Organization Name:PEARSON FACIAL PLASTIC SURGERY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-215-7377
Mailing Address - Street 1:1835 EAST WEST PARKWAY
Mailing Address - Street 2:SUITE 19
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:904-215-7377
Mailing Address - Fax:904-215-7350
Practice Address - Street 1:1835 EAST WEST PARKWAY
Practice Address - Street 2:SUITE 19
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003
Practice Address - Country:US
Practice Address - Phone:904-215-7377
Practice Address - Fax:904-215-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80556207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6912Medicare PIN
FLG42731Medicare UPIN