Basic Information
Provider Information | |||||||||
NPI: | 1649249590 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PEARMAN | ||||||||
FirstName: | BRADLEY | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1932 ALCOA HWY STE 255 | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379201508 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8652442030 | ||||||||
FaxNumber: | 8656841196 | ||||||||
Practice Location | |||||||||
Address1: | 1932 ALCOA HWY STE 255 | ||||||||
Address2: |   | ||||||||
City: | KNOXVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 379201508 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8652442030 | ||||||||
FaxNumber: | 8656841196 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/14/2006 | ||||||||
LastUpdateDate: | 01/31/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 032094 | TN | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 100029550 | 01 |   | PHP | OTHER | 0840285 | 01 |   | UNITED HEALTHCARE | OTHER | 3333333 | 01 |   | UMWA | OTHER | TN0139 | 01 |   | JOHN DEERE | OTHER | 3138049 | 01 |   | BLUE CROSS BLUE SHIELD | OTHER | 180038021 | 01 |   | RAILROAD MEDICARE | OTHER | 5854491 | 01 |   | AETNA | OTHER | 4086370 | 01 |   | CIGNA | OTHER | 3848432 | 05 | TN |   | MEDICAID |