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General NPI Number Information
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NPI Number | 1598756942
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Entity Type | Individual
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Provider Name | JAMES RICHARD PEARSON JR. PAC
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Gender | Male
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 155 SOLANO ST CORNING MEDICAL ASSOCIATES INC
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City | CORNING
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State | CA
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Zip | 96021-3511
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Country | US
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Telephone | 530-824-4663
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Fax | 530-824-5204
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Provider Business Mailing Address
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Address Line | 155 SOLANO ST CORNING MEDICAL ASSOCIATES INC
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City | CORNING
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State | CA
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Zip | 96021-3511
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Country | US
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Telephone | 530-824-4663
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Fax | 530-824-5204
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA12619
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License Number State | CA
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