Provider Demographics
NPI:1366414708
Name:PEARSON, JULENE RANICEA (MD)
Entity type:Individual
Prefix:DR
First Name:JULENE
Middle Name:RANICEA
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 TUSCALOOSA AVE SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1948
Mailing Address - Country:US
Mailing Address - Phone:205-715-6121
Mailing Address - Fax:205-715-6183
Practice Address - Street 1:1308 TUSCALOOSA AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1948
Practice Address - Country:US
Practice Address - Phone:205-715-6121
Practice Address - Fax:205-715-6183
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG592OtherMEDICARE GROUP NUMBER
AL051032285OtherBLUE SHIELD OF AL.
AL303790344Medicaid
AL1396770913OtherGROUP PAYEE NPI
AL051032285OtherBLUE SHIELD OF AL.
AL000032285Medicare PIN