1831374313 NPI number — GURNEY F. PEARSALL MD PA

Table of content: (NPI 1831374313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831374313 NPI number — GURNEY F. PEARSALL MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GURNEY F. PEARSALL MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEARSALL PEDIATRICS
Provider Other Organization Name Type Code:
3
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:
1831374313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2010 NAOMI ST STE C
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:
77054-3837
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:
2010 NAOMI ST STE C
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:
77054-3837
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:
01/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PEARSALL
Authorized Official First Name:
GURNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-790-9265

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080A0000X , with the licence number: D3518 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 121514705 , 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".