Individual
AMANDA W PEARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 RUE DE LA VIE ST, SUITE 100, BATON ROUGE, LA 70817-5126
(225) 201-2000
(225) 201-2110
Mailing address
500 RUE DE LA VIE ST, SUITE 100, BATON ROUGE, LA 70817-5126
(225) 201-2000
(225) 201-2110
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
202076
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03851721
—
MS
01
—
08103071
UP MEDICAID GROUP PROV#
MS
05
—
1187798
—
LA
01
—
512G700003
UP MEDICARE GROUP PROV#
MS
01
—
512I160001
MEDICARE PTAN
MS
01
—
DG7781
UP GROUP RR MCARE
MS
01
—
P00462300
UP RR MEDICARE INDV.
MS
01
—
P00860587
RAILROAD MEDICARE
LA
Enumeration date
06/09/2006
Last updated
09/27/2012
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