Provider Demographics
NPI:1912605205
Name:PEARSON, DANNY
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MEDIJAX
Other - Middle Name:PATIENT
Other - Last Name:TRANSPORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 77612
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-7612
Mailing Address - Country:US
Mailing Address - Phone:904-490-9930
Mailing Address - Fax:
Practice Address - Street 1:297 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-0319
Practice Address - Country:US
Practice Address - Phone:904-490-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)