Healthcare Provider Details

I. General information

NPI: 1568432722
Provider Name (Legal Business Name): BETH S PEARCE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE ORTHOPAEDIC PLACE
ST AUGUSTINE FL
32086-4202
US

IV. Provider business mailing address

ONE ORTHOPAEDIC PLACE
ST AUGUSTINE FL
32086-4202
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-0540
  • Fax: 904-209-1055
Mailing address:
  • Phone: 904-825-0540
  • Fax: 904-209-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO1513
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO1513
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO1513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: