Basic Information
| Provider Information | |||||||||
| NPI: | 1871693648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEARSON | ||||||||
| FirstName: | DARRYL | ||||||||
| MiddleName: | HECTOR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 991 WEST HUDSON BLVD. | ||||||||
| Address2: | GASTON COUNTY HEALTH DEPARTMENT | ||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048535000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 991 WEST HUDSON BLVD. | ||||||||
| Address2: | GASTON COUNTY HEALTH DEPARTMENT | ||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048535000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 32026 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 29989 | 01 | GA | GEORGIA LICENSURE # | OTHER | 66445 | 01 | NC | BCBS NUMBER | OTHER | 8966445 | 05 | NC | MEDICAID | BP2236481 | 01 | DEA NUMBER | OTHER | 32026 | 01 | NC | NC LICENSURE # | OTHER | 13884 | 01 | AL | ALABAMA LICENSURE # | OTHER |