MEDICARE: WILLIAM J PEARSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770727471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J PEARSON

Provider Business Mailing Address
First Line	:	264 CRADLE LAKE DR
Second Line	:
City	:	DIVIDE
State	:	CO
Zip	:	80814-9780
Country	:	US
Telephone Number	:	719-687-3412
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 CRADLE LAKE DR
Second Line	:
City	:	DIVIDE
State	:	CO
Zip	:	80814-9780
Country	:	US
Telephone Number	:	719-687-3412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	04/24/2009

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