Basic Information
Provider Information
NPI: 1336123587
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOVEA
FirstName: PEARL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CHRISTIE
OtherFirstName: PEARL
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 1
Mailing Information
Address1: 1340 S DAMEN AVE
Address2: SUITE 400
City: CHICAGO
State: IL
PostalCode: 606081169
CountryCode: US
TelephoneNumber: 7732924800
FaxNumber: 3125644059
Practice Location
Address1: 2 CHASE CORPORATE DR
Address2: SUITE 300
City: HOOVER
State: AL
PostalCode: 352441016
CountryCode: US
TelephoneNumber: 7732924800
FaxNumber: 3125644059
Other Information
ProviderEnumerationDate: 12/01/2005
LastUpdateDate: 08/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X0101235022VAN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XMD.32028ALY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XN6225TXN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XME110535FLN Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
14394905AL MEDICAID


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