Individual
JERRY KENNETH PEARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
148 13TH ST, SUITE B, TELL CITY, IN 47586-1937
(812) 547-0333
(812) 547-9852
Mailing address
109 US HIGHWAY 66 E, TELL CITY, IN 47586-2755
(812) 547-3447
(812) 547-9543
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
071513
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0540032
BCBS
MI
05
—
103426138
—
MI
01
—
M036898
CHAMPUS PIN
MI
Enumeration date
06/12/2006
Last updated
04/28/2014
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