1417959206 NPI number — MR. JAMES E PEARL MD

Table of content: MR. JAMES E PEARL MD (NPI 1417959206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417959206 NPI number — MR. JAMES E PEARL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARL
Provider First Name:
JAMES
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417959206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 10TH AVE
Provider Second Line Business Practice Location Address:
STE 170
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84103-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-322-1000
Provider Business Practice Location Address Fax Number:
801-408-5556
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  76-159612-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 76-159612-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3046 . This is a "PEHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870371439 . This is a "P5 HEALTH SERVICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000371439 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107990500 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870371439 . This is a "MOLINA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870371439001 . This is a "MBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003011000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107005238103 . This is a "IHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35993 . This is a "DMBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 48844901 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000010006858 . This is a "RGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 31053 . This is a "STATE FARM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 48-00035 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 870371439 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8703714390001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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