Basic Information
| Provider Information | |||||||||
| NPI: | 1649225921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOTER-PEARSALL | ||||||||
| FirstName: | DESIREE | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MEMORIAL HOSPITAL DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145900 | ||||||||
| FaxNumber: | 2512811169 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MEMORIAL HOSPITAL DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145900 | ||||||||
| FaxNumber: | 2512811198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21374 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009927875 | 05 | AL | MEDICAID | 110233518 | 01 | AL | RAILROAD MEDICARE PTAN | OTHER | 000029369 | 05 | AL | MEDICAID | 04-10834 | 01 | AL | UNITED HEALTHCARE | OTHER | 51109805 | 01 | AL | BCBS | OTHER |