Healthcare Provider Details

I. General information

NPI: 1902890403
Provider Name (Legal Business Name): DENNIS PEARMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWINING STREET
MAXWELL AFB AL
36112
US

IV. Provider business mailing address

44 GRAND OAKS BLVD
MILLBROOK AL
36054-2130
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-5143
  • Fax: 334-953-8296
Mailing address:
  • Phone: 334-290-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number063133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: