Individual
DOUGLAS PEARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3551 W ANTELOPE RD, MOORE, ID 83255-8754
(208) 680-5339
Mailing address
3551 W ANTELOPE RD, MOORE, ID 83255-8754
(208) 680-5339
Taxonomy
Speciality
Code
Description
License number
State
343800000X
Secured Medical Transport (VAN)
NS102890G
ID
343900000X
Non-emergency Medical Transport (VAN)
Primary
NS102890G
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06142016715702
—
ID
Enumeration date
01/17/2017
Last updated
01/17/2017
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