Provider Demographics
NPI:1679531578
Name:PEARSON, RICHARD MCQUISTON (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MCQUISTON
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-312-7899
Mailing Address - Fax:901-312-7893
Practice Address - Street 1:7512 SECOND STREET
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-312-7899
Practice Address - Fax:901-312-7893
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN07601208800000X
MS11876208800000X
TN7601208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2575594OtherCIGNA
19925000040OtherQUAL CHOICE
12940428OtherPHCS
3000133OtherTLC (TENNCARE)
86727OtherBLUE CROSS AR
12940428OtherHEALTH ASSURANCE EPA
209810OtherHEALTH LINK
TN3162592Medicaid
4025952OtherAETNA
887420OtherFIRST HEALTH
TN0176435OtherBLUE CROSS
211159OtherSOUTHERN HEALTH SERVICES
TN0176435OtherBLUE CROSS
340011663Medicare ID - Type UnspecifiedRAILROAD MEDICARE
4025952OtherAETNA
211159OtherSOUTHERN HEALTH SERVICES