Basic Information
Provider Information
NPI: 1003801382
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEARSON
FirstName: DONALD
MiddleName: EDWARD
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 77 WEST UNDERWOOD ST
Address2: 5TH FL
City: ORLANDO
State: FL
PostalCode: 32806
CountryCode: US
TelephoneNumber: 4078432130
FaxNumber: 4074253984
Practice Location
Address1: 77 WEST UNDERWOOD ST
Address2: 5TH FLOOR
City: ORLANDO
State: FL
PostalCode: 32806
CountryCode: US
TelephoneNumber: 4078432130
FaxNumber: 4074253984
Other Information
ProviderEnumerationDate: 09/13/2005
LastUpdateDate: 05/13/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XME0013045FLY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
05537510005FL MEDICAID


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