Individual
RUSSELL PEARL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
1460 G ST, SPRINGFIELD, OR 97477-4112
(541) 726-4510
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-6328
(253) 838-6180
(253) 838-6418
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
PA10005135
WA
363A00000X
Physician Assistant
PA01307
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0216544
LIWA
WA
01
—
3454PE
BSWA
WA
05
—
8471328
—
WA
01
—
P91043
UPIN
WA
01
—
PEA1967
NPI LOGIN
WA
Enumeration date
01/04/2007
Last updated
05/21/2008
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