Healthcare Provider Details

I. General information

NPI: 1780739482
Provider Name (Legal Business Name): PEARSON FACIAL PLASTIC SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/09/2008
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: DR. DAVID CRAIG PEARSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-215-7377