MEDICARE: HARVEY A PEARL DPM PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013312024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVEY A PEARL DPM PA

Provider Business Mailing Address
First Line	:	2324 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2021
Country	:	US
Telephone Number	:	904-737-4166
Fax Number	:	904-737-4322

Provider Business Practice Location Address
First Line	:	2324 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2021
Country	:	US
Telephone Number	:	904-737-4166
Fax Number	:	904-737-4322

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	MR. HARVEY A PEARL
Credential	:	DPM PA
Telephone Number	:	904-737-4166

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	12/18/2014

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