Healthcare Provider Details

I. General information

NPI: 1679716815
Provider Name (Legal Business Name): ALAN L PEARLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CALLE DEL REY
SANTA FE NM
87506-8524
US

IV. Provider business mailing address

1300 CALLE DEL REY
SANTA FE NM
87506-8524
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-0107
  • Fax: 505-820-0107
Mailing address:
  • Phone: 505-820-0107
  • Fax: 505-820-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2002-0477
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: