1104994730 NPI number — DR. GURNEY FIELDS PEARSALL SR. M.D.,F.A.A.P.

Table of content: DR. ISABEL LOTT MD (NPI 1093456600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104994730 NPI number — DR. GURNEY FIELDS PEARSALL SR. M.D.,F.A.A.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSALL
Provider First Name:
GURNEY
Provider Middle Name:
FIELDS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
M.D.,F.A.A.P.
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:
1104994730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3003 S LOOP W STE 410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77054-1383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-790-9265
Provider Business Mailing Address Fax Number:
713-790-1006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 S LOOP W STE 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77054-1383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-790-9265
Provider Business Practice Location Address Fax Number:
713-790-1006
Provider Enumeration Date:
12/01/2006

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: 208000000X , with the licence number:  D3518 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 121514702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121514701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145015701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25284 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84Z311 . This is a "BLU CROSS & BLUE SHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 121514703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121514705 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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