MEDICARE: MR. JAMES E PEARL MD

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	76-159612-1205	UT
2	207RP1001X	Pulmonary Disease Physician	76-159612-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3046	OTHER		PEHP
2	870371439	OTHER		P5 HEALTH SERVICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	870371439	OTHER		MOLINA
6	870371439001	OTHER		MBA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	107005238103	OTHER		IHC
9	35993	OTHER		DMBA
10	48844901	OTHER		FIRST HEALTH
11	000010006858	OTHER	ID	RGENCE BLUE SHIELD
12	31053	OTHER		STATE FARM
13	48-00035	OTHER		UHC
14	870371439	OTHER		AETNA
15	8703714390001	OTHER		CIGNA

General Provider Information

NPI Number	:	1417959206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES E PEARL MD

Provider Business Mailing Address
First Line	:	324 10TH AVE
Second Line	:	STE 170
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2853
Country	:	US
Telephone Number	:	801-322-1000
Fax Number	:	801-408-5556

Provider Business Practice Location Address
First Line	:	324 10TH AVE
Second Line	:	STE 170
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2853
Country	:	US
Telephone Number	:	801-322-1000
Fax Number	:	801-408-5556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	09/15/2021

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