Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | Q9152 | TX |
Y | 207YP0228X | Pediatric Otolaryngology | Q9152 | TX |
NPI | 1164743472 |
---|---|
Provider Name | Dr. Marisa Anne Earley |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 21/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
360992701 | (05) | TX |
360992702 | CSHCN (01) | TX |
518323YK00 | (02) | TX |