Provider Demographics
NPI:1306913876
Name:PEARSON, EDWARD W (MD , ABIHM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:W
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD , ABIHM
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Other - First Name:
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Mailing Address - Street 1:1201 US HIGHWAY 1
Mailing Address - Street 2:SUITE 46
Mailing Address - City:N PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3550
Mailing Address - Country:US
Mailing Address - Phone:561-290-4325
Mailing Address - Fax:561-629-7291
Practice Address - Street 1:1201 US HIGHWAY 1
Practice Address - Street 2:SUITE 46
Practice Address - City:N PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3550
Practice Address - Country:US
Practice Address - Phone:561-290-4325
Practice Address - Fax:561-629-7291
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME83846208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11012OtherBCBS
FL2657406-00Medicaid
FL2657406-00Medicaid
FLBP6852291OtherDEA
FL2657406-00Medicaid