Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | PA14973 | CA |
NPI | 1033221262 |
---|---|
Provider Name | John D Pearson |
First Address | Redding, CA 96049-6084 |
Second Address | Redding, CA 96001-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 02/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OPA149730 | TRICARE (01) | CA |
OPA149733 | MEDICARE (01) | CA |
P13549 | (02) |