=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013950484
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAROLD J PEAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 11/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 BUSINESS PARK DR STE 6
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-6054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-519-0770
-----------------------------------------------------
Fax | 956-519-0718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1708
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78573-0030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-519-0770
-----------------------------------------------------
Fax | 956-519-0718
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | J3185
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------