Individual
DR. WALLACE GEORGE PEARSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1414 W FAIR AVE, SUITE 149, MARQUETTE, MI 49855
(906) 228-7020
(906) 228-9371
Mailing address
1414 W FAIR AVE, SUITE 149, MARQUETTE, MI 49855-2675
(906) 228-7020
(906) 228-9371
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301065569
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E26013
BLUE CROSS BLUE SHIELD MI
MI
05
—
3169700
—
MI
Enumeration date
08/10/2006
Last updated
07/05/2018
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