Healthcare Provider Details

I. General information

NPI: 1932555885
Provider Name (Legal Business Name): MITCHELL PEARCE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 E 33RD ST
BROOKLYN NY
11234-4423
US

IV. Provider business mailing address

1739 E 33RD ST
BROOKLYN NY
11234-4423
US

V. Phone/Fax

Practice location:
  • Phone: 931-952-8629
  • Fax:
Mailing address:
  • Phone: 931-952-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number325894
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDOS-3021
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberS9968
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: