Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 49213 | MN |
N | 207Q00000X | Family Doctor | 9879 | ND |
NPI | 1003835984 |
---|---|
Provider Name | Eric Carl Pearson |
First Address | East Grand Forks, MN 56721-1917 |
Second Address | East Grand Forks, MN 56721-1917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 18/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0124339 | MEDICA (01) | |
13492 | (05) | ND |
27032 | BCBS (01) | ND |
488P7PE | BCBS (01) | MN |
999643500 | (05) | MN |
HP69865 | HEALTHPARTNERS (01) | |
I34487 | (02) | |
NA4571045037 | PREFERRED ONE (01) |