Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 011379 | GA |
NPI | 1053532937 |
---|---|
Provider Name | Dr. Robert Mark Pearson |
First Address | Valdosta, GA 31605 |
Second Address | Valdosta, GA 31605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |