Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | L9626 | TX |
NPI | 1073717252 |
---|---|
Provider Name | Ms. Shirley Ann Pearce |
First Address | Alpine, TX 79830-3208 |
Second Address | Alpine, TX 79830-3208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 25/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
193110701 | (05) | TX |
193110702 | (05) | TX |