Provider Demographics
NPI:1144262742
Name:PEARSON, ANTHONY C (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
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 1:222 S WOODS MILL RD
Mailing Address - Street 2:STE 500 N
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-205-6699
Mailing Address - Fax:314-205-6085
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:STE 500 N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-205-6699
Practice Address - Fax:314-590-5923
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32521207RC0000X
MO2007018944207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY060036505OtherRAILROAD MEDICARE NUMBER
IN200109350AMedicaid
KY2433844000OtherPASSPORT ADVANTAGE PIN
KY64325210Medicaid
KY000000076256OtherANTHEM PIN
KY1056152OtherPASSPORT PIN
KY0558302Medicare ID - Type UnspecifiedJEWISH OFF MEDICARE NUMBE
KY64325210Medicaid
KY000000076256OtherANTHEM PIN
IN200109350AMedicaid
MO311734699Medicare PIN