Provider Demographics
NPI:1487602991
Name:CARRILLO, PEARL (DO)
Entity type:Individual
Prefix:DR
First Name:PEARL
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SOUTH 65 HIGHWAY
Mailing Address - Street 2:P O BOX 158
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-886-7431
Mailing Address - Fax:660-886-9001
Practice Address - Street 1:2305 S HIGHWAY 65 BLDG A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-7800
Practice Address - Fax:660-831-3306
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007001548208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205472509Medicaid
MO38337016OtherBLUE CROSS BLUE SHIELD OF KC
MO795915OtherHEALTHLINK PIN
MOH43884OtherMERCY HEALTH PLANS PIN
MO7713239OtherAETNA PIN
MO795915OtherHEALTHLINK PIN
MO38337016OtherBLUE CROSS BLUE SHIELD OF KC
MO205472509Medicaid
X43000008Medicare PIN