Provider Demographics
NPI:1063417236
Name:LEE ANN PEARSE, M.D., P.A.
Entity type:Organization
Organization Name:LEE ANN PEARSE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-5622
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:STE B141
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2527
Mailing Address - Country:US
Mailing Address - Phone:972-566-5622
Mailing Address - Fax:972-566-5616
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:STE B141
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2527
Practice Address - Country:US
Practice Address - Phone:972-566-5622
Practice Address - Fax:972-566-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK45242080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE61623Medicare UPIN
TX00905WMedicare ID - Type UnspecifiedM/CARE #