Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | F1521 | TX |
NPI | 1003811514 |
---|---|
Provider Name | Michael Anthony Earle |
First Address | San Antonio, TX 78217-5419 |
Second Address | San Antonio, TX 78217-5419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B87668 | (02) | TX |