Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | K4524 | TX |
NPI | 1184629347 |
---|---|
Provider Name | Lee Ann Pearse |
First Address | Dallas, TX 75230-2527 |
Second Address | Dallas, TX 75230-2527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 15/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1297350-06 | (05) | TX |
E62623 | (02) | TX |