Provider Demographics
NPI:1902939242
Name:PEARSON, MICHAEL ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROY
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 1:7120 MUIRKIRK LN SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6404
Mailing Address - Country:US
Mailing Address - Phone:360-874-6867
Mailing Address - Fax:360-895-3251
Practice Address - Street 1:7120 MUIRKIRK LN SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6404
Practice Address - Country:US
Practice Address - Phone:360-874-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000152442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01826OtherREGENCE RIDER
WA0021557OtherL&I
WA0021557OtherL&I
WAAP7154166OtherDEA
WAP01826OtherREGENCE RIDER