Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD00026260 | WA |
NPI | 1003815028 |
---|---|
Provider Name | Stephen J Pearson |
First Address | Yakima, WA 98902-3550 |
Second Address | Yakima, WA 98902-2473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 11/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0155743 | LABOR & INDUSTRIES (01) | WA |
8130023 | (05) | WA |
P00050791 | RAILROAD MEDICARE (01) | WA |