Healthcare Provider Details

I. General information

NPI: 1659390086
Provider Name (Legal Business Name): ALLISON L PEARL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/01/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5217 S STATE ST
MURRAY UT
84107-4813
US

IV. Provider business mailing address

5217 S STATE ST
MURRAY UT
84107-4813
US

V. Phone/Fax

Practice location:
  • Phone: 801-313-4118
  • Fax:
Mailing address:
  • Phone: 801-313-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number200301398
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA97651
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12649599-1205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD28262
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: