Healthcare Provider Details

I. General information

NPI: 1558322610
Provider Name (Legal Business Name): DAVID CRAIG PEARSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 EAST WEST PARKWAY SUITE 19
ORANGE PARK FL
32003
US

IV. Provider business mailing address

1835 EAST WEST PARKWAY SUITE 19
ORANGE PARK FL
32003
US

V. Phone/Fax

Practice location:
  • Phone: 904-215-7377
  • Fax: 904-215-7350
Mailing address:
  • Phone: 904-215-7377
  • Fax: 904-215-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME80556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: