Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 20A5534 | CA |
NPI | 1255449138 |
---|---|
Provider Name | Dr. Jeffrey Keith Pearson |
First Address | Carlsbad, CA 92008-1688 |
Second Address | Carlsbad, CA 92008-1688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 22/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C54095 | (02) | CA |