Individual
DR. LARRY CHARLES PEARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 N BARKER RD, 110, BROOKFIELD, WI 53045-5929
(262) 785-0777
(262) 785-0610
Mailing address
601 N BARKER RD, 110, BROOKFIELD, WI 53045-5929
(262) 785-0777
(262) 785-0610
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
21803
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110094338
RAILROAD MEDICARE
WI
05
—
30304600
—
WI
01
—
387464687004
BLUE CROSS/ BLUE SHIELD
WV
Enumeration date
08/04/2005
Last updated
10/31/2019
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